title: Hyperinsulinemic euglycemia therapy for verapamil poisoning: case report.
abstract: A 49-year-old woman was brought to the emergency department because of an intentional overdose of sustained-release verapamil along with captopril and glyburide. The estimated interval between ingestion and the time she was found was several hours. Initial findings were blood pressure 72/39 mm Hg, heart rate 32/min, and a score of 9 on the Glasgow Coma Scale. She was intubated and given intravenous fluid and vasopressor support. Decontamination with activated charcoal was instituted. Administration of dopamine and norepinephrine, atropine, sodium bicarbonate, and calcium chloride did not yield significant clinical improvement. Hyperinsulinemic euglycemia therapy was started: a bolus of regular insulin then infusions of insulin and 10% dextrose. After 24 hours of therapy, the bradycardia resolved and the patient's hemodynamic condition stabilized with normalization of cardiac indices. On day 5 the patient was transferred to the medical unit, and on day 8 she was discharged to psychiatric care.
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: D000931:Antidotes / Q000627:therapeutic use*; D002216:Captopril / Q000008:administration & dosage; D003422:Critical Care / Q000379:methods; D004338:Drug Combinations; D005260:Female; D005905:Glyburide / Q000008:administration & dosage; D006801:Humans; D006946:Hyperinsulinism; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D008875:Middle Aged; D011041:Poisoning / Q000188:drug therapy*; D016896:Treatment Outcome; D014481:United States; D014700:Verapamil / Q000506:poisoning*
chemical_list: D000931:Antidotes; D004338:Drug Combinations; D007004:Hypoglycemic Agents; D007328:Insulin; D002216:Captopril; D014700:Verapamil; D005905:Glyburide