Stability of high-dose insulin in normal saline bags for treatment of calcium channel blocker and beta blocker overdose

Abstract

Insulin at a concentration of 16 units/mL is stable for 14 days, the maximum timeframe currently allowed under US Pharmacopeia rules for compounding of sterile preparations. This stability data will allow institutions to issue beyond-use dating for intravenous fluids containing concentrated insulin and used for treating beta blocker and calcium channel blocker toxicity.

High‐dose insulin should be used before vasopressors/inotropes in calcium‐channel blocker toxicity

“…High doses up to 22 IU/kg/h were shown to be safe 24 . Insulin is stable for 14 days at a concentration of 16 IU/mL, allowing hospitals to issue beyond‐use dating for intravenous fluids containing concentrated insulin for prompt administration in CCB poisonings 26 . HDI therapy duration is guided by the cardiovascular response.…”

“…24 Insulin is stable for 14 days at a concentration of 16 IU/mL, allowing hospitals to issue beyond-use dating for intravenous fluids containing concentrated insulin for prompt administration in CCB poisonings. 26 HDI therapy duration is guided by the cardiovascular response. HDI weaning should be considered once stability after catecholamine withdrawal is obtained.…”

An Overview of Hyperinsulinemic‐Euglycemic Therapy in Calcium Channel Blocker and β‐blocker Overdose

“…It may be wise to consider a standard distinct insulin concentration for BB/CCB overdose to help avoid errors in medication compounding or administration. One 2016 study found that insulin was stable at a concentration of 16 units/ml for 14 days . This concentration would be easily recognizable so as not to be mistaken for the standard 1 unit/ml preparation often stocked in health systems within the United States.…”

“…One 2016 study found that insulin was stable at a concentration of 16 units/ml for 14 days. 42 This concentration would be easily recognizable so as not to be mistaken for the standard 1 unit/ml preparation often stocked in health systems within the United States. Preparations at higher concentrations may be an area for future research.…”

Risk of Fluid Overload From Failure to Concentrate High-Dose Insulin as an Intravenous Antidote

“…Regular insulin is typically added to normal saline, to a final concentration of 1 U/mL; however, it is stable at 16 U/mL with normal saline for 2 weeks at room temperature in a polyvinyl chloride IV bag. 3 Laskey et al 3 chose to examine the stability of 16 U/mL instead of 10 U/mL to mitigate 10-fold dosing errors. We advise concentrating insulin when used as an antidote to minimize volume overload.…”