TY - JOUR
T1 - High-dose insulin and intravenous lipid emulsion therapy for cardiogenic shock induced by intentional calcium-channel blocker and beta-blocker overdose
T2 - A case series
AU - Doepker, Bruce
AU - Healy, William
AU - Cortez, Eric
AU - Adkins, Eric J.
PY - 2014/4
Y1 - 2014/4
N2 - 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.
AB - 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.
KW - beta blocker
KW - calcium-channel blocker
KW - high-dose insulin
KW - lipid emulsion
KW - overdose
UR - http://www.scopus.com/inward/record.url?scp=84898601778&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84898601778&partnerID=8YFLogxK
U2 - 10.1016/j.jemermed.2013.08.135
DO - 10.1016/j.jemermed.2013.08.135
M3 - Article
C2 - 24530120
AN - SCOPUS:84898601778
SN - 0736-4679
VL - 46
SP - 486
EP - 490
JO - Journal of Emergency Medicine
JF - Journal of Emergency Medicine
IS - 4
ER -