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Hyperinsulinemia euglycemia therapy for calcium channel blocker overdose: a case report.
Tex Heart Inst J. 2012; 39(4):575-8.TH

Abstract

We report the case of a patient with calcium channel blocker toxicity who was treated successfully with hyperinsulinemia euglycemia therapy, without prior use of vasopressors. The patient was a 60-year-old man with schizoaffective disorder who presented with severe hemodynamic compromise after an intentional overdose of 5,400 mg of extended-release diltiazem. He had been admitted to the hospital twice before for attempted suicide with diltiazem and nifedipine, respectively. During the previous admissions, conventional treatments were used, and complications included hemodynamic compromise, ischemic bowel requiring ileostomy, and a prolonged hospital stay. During the current admission, the patient's clinical condition failed to improve after treatment with charcoal, fluid resuscitation, calcium, and glucagon. Eight hours after admission, hyperinsulinemia euglycemia therapy was initiated; 3 hours later, the patient's hemodynamic status showed sustained improvement. His bradycardia and hypotension resolved without cardiac pacing or vasopressors. Hyperinsulinemia euglycemia therapy is a potentially life-saving treatment for calcium channel blocker toxicity. We suggest that such therapy should be considered early, in conjunction with conventional therapy, for the treatment of calcium channel blocker overdose in patients not responding to initial treatment.

Authors+Show Affiliations

Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois 62702, USA. anudr28@gmail.comNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

22949783

Citation

Agarwal, Anushree, et al. "Hyperinsulinemia Euglycemia Therapy for Calcium Channel Blocker Overdose: a Case Report." Texas Heart Institute Journal, vol. 39, no. 4, 2012, pp. 575-8.
Agarwal A, Yu SW, Rehman A, et al. Hyperinsulinemia euglycemia therapy for calcium channel blocker overdose: a case report. Tex Heart Inst J. 2012;39(4):575-8.
Agarwal, A., Yu, S. W., Rehman, A., & Henkle, J. Q. (2012). Hyperinsulinemia euglycemia therapy for calcium channel blocker overdose: a case report. Texas Heart Institute Journal, 39(4), 575-8.
Agarwal A, et al. Hyperinsulinemia Euglycemia Therapy for Calcium Channel Blocker Overdose: a Case Report. Tex Heart Inst J. 2012;39(4):575-8. PubMed PMID: 22949783.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hyperinsulinemia euglycemia therapy for calcium channel blocker overdose: a case report. AU - Agarwal,Anushree, AU - Yu,Siegfried W, AU - Rehman,Abdul, AU - Henkle,Joseph Q, PY - 2012/9/6/entrez PY - 2012/9/6/pubmed PY - 2013/1/23/medline KW - Calcium channel blockers KW - diltiazem KW - hyperinsulinemia euglycemia therapy KW - insulin/therapeutic use SP - 575 EP - 8 JF - Texas Heart Institute journal JO - Tex Heart Inst J VL - 39 IS - 4 N2 - We report the case of a patient with calcium channel blocker toxicity who was treated successfully with hyperinsulinemia euglycemia therapy, without prior use of vasopressors. The patient was a 60-year-old man with schizoaffective disorder who presented with severe hemodynamic compromise after an intentional overdose of 5,400 mg of extended-release diltiazem. He had been admitted to the hospital twice before for attempted suicide with diltiazem and nifedipine, respectively. During the previous admissions, conventional treatments were used, and complications included hemodynamic compromise, ischemic bowel requiring ileostomy, and a prolonged hospital stay. During the current admission, the patient's clinical condition failed to improve after treatment with charcoal, fluid resuscitation, calcium, and glucagon. Eight hours after admission, hyperinsulinemia euglycemia therapy was initiated; 3 hours later, the patient's hemodynamic status showed sustained improvement. His bradycardia and hypotension resolved without cardiac pacing or vasopressors. Hyperinsulinemia euglycemia therapy is a potentially life-saving treatment for calcium channel blocker toxicity. We suggest that such therapy should be considered early, in conjunction with conventional therapy, for the treatment of calcium channel blocker overdose in patients not responding to initial treatment. SN - 1526-6702 UR - https://www.unboundmedicine.com/medline/citation/22949783/Hyperinsulinemia_euglycemia_therapy_for_calcium_channel_blocker_overdose:_a_case_report_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=linkout&SEARCH=22949783.ui DB - PRIME DP - Unbound Medicine ER -