Insulin-glucose as adjunctive therapy for severe calcium channel antagonist poisoning.
This case series documents the clinical courses of 4 patients after verapamil overdose and 1 patient after amlodipine-atenolol overdose. All subjects had hypodynamic circulatory shock (hypotension, bradycardia, and acidosis) that was not adequately responsive to conventional treatment. After initiation of insulin-dextrose infusion, the hemodynamic status of all 5 patients stabilized and all patients survived. Plasma drug concentrations are reported for all cases and verapamil levels were extremely high in 2 patients (3710 ng/mL and 3980 ng/mL). However, because patients were not treated according to a standard protocol, each patient received variable other supportive measures and inotropic agents, and the infusion rates of insulin were variable among patients. This report provides preliminary evidence toward a larger trial of insulin-dextrose to treat hypodynamic shock from calcium channel blocker overdose.
Yuan
T H
TH
Carolinas Medical Center, Charlotte, North Carolina 28232, USA.
Kerns
W P
WP
Tomaszewski
C A
CA
Ford
M D
MD
Kline
J A
JA
D000293:Adolescent; D000328:Adult; D017311:Amlodipine / Q000097:blood / Q000506:poisoning; D001262:Atenolol / Q000097:blood / Q000506:poisoning; D002121:Calcium Channel Blockers / Q000097:blood / Q000506:poisoning*; D017024:Chemotherapy, Adjuvant; D005260:Female; D005947:Glucose / Q000627:therapeutic use*; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D013406:Suicide, Attempted; D014700:Verapamil / Q000097:blood / Q000506:poisoning
D002121:Calcium Channel Blockers; D007328:Insulin; D017311:Amlodipine; D001262:Atenolol; D014700:Verapamil; D005947:Glucose