title: Hyperinsulinemic-euglycemic therapy for intoxication with calcium channel blockers.
abstract: Conventional therapy for intoxication with calcium channel blockers consists of crystalloid solutions, calcium gluconate, glucagon and vasopressor agents. These therapies often fail to improve hemodynamic function in intoxicated patients. The pathophysologic mechanism proposed for intoxication with these agents, suggest hypoinsulinemia as the determinant factor. We will describe the case of a 77 years old man treated for an overdose of nifedipine and atenolol who arrived at our institution with hypotension and bradycardia. After conventional therapy failed to improve the patient's hemodynamic status, hyperinsulinemia and euglycemia contributed to the improvement of the patient's neurologic and hemodynamic condition. Thus, hyperinsulinemic-euglycemic therapy was of benefit in this patient with hemodynamic compromise secondary to intoxication with calcium channel blocker not responding to conventional therapy. We will review the mechanism of action of calcium channel blocker drugs as well as the clinical presentation and treatment options for calcium channel blocker intoxication.
authors.affiliation: Internal Medicine Program, Veterans Affairs Hospital, San Juan, Puerto Rico. lortiz5@hotmail.com
authors.forename: Luis
authors.initials: L
authors.lastname: Ortiz-Muñoz
authors.forename: Luis F
authors.initials: LF
authors.lastname: Rodriguez-Ospina
authors.forename: Manuel
authors.initials: M
authors.lastname: Figueroa-Gonzalez
mesh_terms: D000368:Aged; D000818:Animals; D000931:Antidotes / Q000627:therapeutic use*; D001262:Atenolol / Q000506:poisoning*; D002121:Calcium Channel Blockers / Q000506:poisoning*; D002125:Calcium Gluconate / Q000008:administration & dosage; D004195:Disease Models, Animal; D062787:Drug Overdose; D005934:Glucagon / Q000008:administration & dosage*; D005947:Glucose / Q000008:administration & dosage*; D006801:Humans; D006946:Hyperinsulinism; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D009543:Nifedipine / Q000506:poisoning*; D051381:Rats; D016896:Treatment Outcome
chemical_list: D000931:Antidotes; D002121:Calcium Channel Blockers; D007004:Hypoglycemic Agents; D007328:Insulin; D001262:Atenolol; D005934:Glucagon; D009543:Nifedipine; D005947:Glucose; D002125:Calcium Gluconate