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When conventional therapy failed to improve the hemodynamic status of these patients, hyperinsulinemia–euglycemia therapy with a continuous infusion of insulin at a rate of 0.5 IU per kilogram of body weight per hour rapidly reversed cardiovascular collapse in both.

Clinical Courses of Two Patients Treated with Hyperinsulinemia–Euglycemia Therapy. He became hemodynamically unstable in the emergency department and did not respond to calcium, intravenous fluids, and vasopressors.

Because of her history of renal failure, the treating physicians did not administer calcium and instead provided intravenous fluids, vasopressors, and glucagon.Ī 48-year-old nondiabetic man with hypertension, chronic obstructive pulmonary disease, congestive heart failure, and depression was witnessed ingesting an unknown amount of extended-release diltiazem. 3 We report two cases of overdose of calcium-channel blockers in which a striking benefit was achieved with hyperinsulinemia–euglycemia therapy.Ī 34-year-old nondiabetic woman with hypertension and renal failure ingested 12 extended-release tablets containing 2.5 mg of amlodipine each. 2 Recent recommendations for treatment of intoxication with calcium-channel blockers include induction of hyperinsulinemia and euglycemia as adjunctive therapy. 1 Conventional therapy, consisting of intravenous fluids, calcium, dopamine, dobutamine, norepinephrine, and glucagon, often fails to improve hemodynamic function in intoxicated patients. Overdose of calcium-channel blockers remains an important cause of fatal poisoning. The most trusted, influential source of new medical knowledge and clinical best practices in the world. Information and tools for librarians about site license offerings. Valuable tools for building a rewarding career in health care. The authorized source of trusted medical research and education for the Chinese-language medical community. The most advanced way to teach, practice, and assess clinical reasoning skills. Information, resources, and support needed to approach rotations - and life as a resident. The most effective and engaging way for clinicians to learn, improve their practice, and prepare for board exams.

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