The use of low-dose insulin in cardiogenic shock due to combined overdose of verapamil, enalapril and metoprolol.
We describe a case of severe heart failure due to the combined effect of verapamil and enalapril overdose in a patient treated regularly with metoprolol. The patient was dependent for 2 days on glucagon and dopamine infusion but remained oliguric, with deteriorating renal function. Marked improvement in all hemodynamic parameters was noted a short time after initiation of treatment with low-dose insulin infusion (1-2 units/h), which allowed the prompt withdrawal of glucagon and dopamine. We discuss the efficacy of glucose-insulin treatment in toxic cardiac depression and suggest that a low dose may be beneficial in similar cases.
Hasin
Tal
T
Department of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. hasintal@zahav.net.il
Leibowitz
David
D
Antopolsky
Meir
M
Chajek-Shaul
Tova
T