title: Hyperinsulinemic euglycemia therapy for verapamil poisoning: a review.
abstract: Treatment of patients with verapamil overdose remains challenging. Traditional decontamination and supportive measures with intravenous calcium and vasopressors are the mainstays in initial care. Recently, the successful use of rescue hyperinsulinemic euglycemia therapy has been described in multiple cases. Treatment resulted in improved hemodynamic parameters and increased metabolic efficiency in patients with a low-output, myocardial shock state. Information on clinical use of hyperinsulinemic euglycemia therapy in humans is limited to case reports and small case series; no controlled clinical trials have been done. Hyperinsulinemic euglycemia therapy should be considered for patients with calcium channel blocker overdose who do not respond to initial supportive therapy.
authors.affiliation: Division of Pulmonary, Allergy, and Critical Care Medicine and the Center for Sleep and Respiratory Neurobiology, Hospital of the University of Pennsylvania, 3600 Spruce Street, Philadelphia, PA 19104, USA. nirav.patel@uphs.upenn.edu
authors.forename: Nirav P
authors.initials: NP
authors.lastname: Patel
authors.forename: Meredith E
authors.initials: ME
authors.lastname: Pugh
authors.forename: Steven
authors.initials: S
authors.lastname: Goldberg
authors.forename: Glenn
authors.initials: G
authors.lastname: Eiger
mesh_terms: D000818:Animals; D000931:Antidotes / Q000627:therapeutic use*; D003422:Critical Care / Q000379:methods; D006801:Humans; D006946:Hyperinsulinism; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D014481:United States; D014700:Verapamil / Q000506:poisoning*
chemical_list: D000931:Antidotes; D007004:Hypoglycemic Agents; D007328:Insulin; D014700:Verapamil