Management of Severe Beta-Blockers Toxicity with High Dose Insulin Euglycemic Therapy: A Case Report

Abstract

Aims: Highlighting the efficacy of early initiation of high dose insulin therapy in Beta-blockers overdose over conventional therapy.
 Presentation of Case: Authors describe the successful treatment of severe bisoprolol-induced cardiogenic shock in a 74-year-old man using high dose insulin euglycemic therapy. He received intravenous bolus of 1IU/kg of actarapid insulin followed by intravenous infusion of 0.5 IU/kg/hour. The patient hemodynamic parameters improved dramatically within few hours after starting the insulin therapy.
 Discussion: Beta-blockers overdose can lead to significant morbidity and mortality due to the often-associated vasopressor-resistant shock. high dose insulin euglycemic therapy is a potential emerging therapy for beta-blockers toxicity with support in the literature from several animal studies, case reports and expert opinion.
 Conclusion: High dose insulin euglycemic therapy is a safe and effective method in reversing the hemodynamic consequences induced by beta-blockers overdose and should be used early in the treatment.