Citation

Doepker B, Healy W, Cortez E, Adkins EJ. J. Emerg. Med. 2014; 46(4): 486-490.

Copyright

(Copyright © 2014, Elsevier Publishing)

DOI

10.1016/j.jemermed.2013.08.135

PMID

unavailable

Abstract

Background Recently, high-dose insulin (HDI) and intravenous lipid emulsion (ILE) have emerged as treatment options for severe toxicity from calcium-channel blocker (CCB) and beta blocker (BB).

OBJECTIVE Our aim was to describe the use and effectiveness of HDI and ILE for the treatment of CCB and BB overdose. Case Reports We describe 2 patients presenting to the emergency department after intentional ingestions of CCBs and BBs. A 35-year-old man presented in pulseless electrical activity after ingesting amlodopine, verapamil, and metoprolol. A 59-year-old man presented with cardiogenic shock (CS) after ingesting amlodopine, simvastatin, lisinopril, and metformin. Both patients were initially treated with glucagon, calcium, and vasopressors. Shortly after arrival, HDI (1 unit/kg × 1; 1 unit/kg/h infusion) and ILE 20% (1.5 mL/kg × 1; 0.25 mL/kg/min × 60 min) were initiated. This led to hemodynamic improvement and resolution of shock. At the time of hospital discharge, both patients had achieved full neurologic recovery.

CONCLUSIONS HDI effectively reverses CS induced by CCBs and BBs due to its inotropic effects, uptake of glucose into cardiac muscle, and peripheral vasodilatation. ILE is theorized to sequester agents dependent on lipid solubility from the plasma, preventing further toxicity. To our knowledge, these are the first two successful cases reported using the combination of HDI and ILE for reversing CS induced by intentional ingestions of CCBs and BBs. © 2014 Elsevier Inc.

Language: en

Keywords

Humans; Adult; Male; Middle Aged; adult; human; male; Drug Overdose; Suicide, Attempted; case report; suicide attempt; complication; disease severity; overdose; drug overdose; Insulin; article; priority journal; disease course; middle aged; intensive care unit; noradrenalin; dopamine; emergency ward; pH; activated carbon; drug efficacy; beta adrenergic receptor blocking agent; hospital discharge; hemodynamics; hypotension; drug megadose; acute kidney failure; simvastatin; atropine; hypertension; glucose blood level; hyperlipidemia; glucose; adrenalin; bicarbonate; glibenclamide; hypoglycemia; insulin; creatinine; creatinine blood level; midazolam; calcium channel blocking agent; insulin dependent diabetes mellitus; gluconate calcium; metabolic acidosis; electrocardiography; glucagon; Calcium Channel Blockers; bradycardia; blood pressure; lactic acidosis; metformin; calcium; oxygen saturation; insulin pump; verapamil; metoprolol; hyperkalemia; medical history; treatment duration; vital sign; amlodipine; sinus bradycardia; restless legs syndrome; calcium chloride; Adrenergic beta-Antagonists; chemically induced; anion gap; cardiogenic shock; lisinopril; breathing rate; Shock, Cardiogenic; hypertensive factor; insulin infusion; lipid emulsion; Fat Emulsions, Intravenous; electric activity; beta blocker; calcium-channel blocker; high-dose insulin