The use of high-dose insulin-glucose euglycemia in beta-blocker overdose: a case report.
The management of life-threatening beta-blocker toxicity and its associated low cardiac output state is clinically challenging. Previous case reports and case series describe the use of hyperinsulinemia/euglycemia therapy in mono-ingestions of calcium channel blockers and mixed ingestions, including calcium channel and beta-blockers. In this case report we describe the use of high-dose insulin (10 IU/kg per hour) in a case of massive metoprolol ingestion (5g) in which hypotension was unresponsive to conventional therapies. Although the metoprolol concentrations measured in plasma were approximately 100-200 times therapeutic concentrations, the pharmacokinetics appeared to be similar to therapeutic metoprolol dosing.
Page
Colin
C
Department of Clinical Toxicology and Pharmacology, Calvary Mater Newcastle Hospital, Newcastle, NSW, Australia. cpage@bigpoint.net.au
Hacket
L Peter
LP
Isbister
Geoffrey K
GK
D000319:Adrenergic beta-Antagonists / Q000097:blood / Q000493:pharmacokinetics / Q000506:poisoning*; D000931:Antidotes / Q000008:administration & dosage*; D001786:Blood Glucose / Q000187:drug effects; D001794:Blood Pressure / Q000187:drug effects; D003422:Critical Care; D004334:Drug Administration Schedule; D062787:Drug Overdose; D005260:Female; D005947:Glucose / Q000008:administration & dosage*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007022:Hypotension / Q000097:blood / Q000139:chemically induced / Q000188:drug therapy* / Q000503:physiopathology; D007263:Infusions, Parenteral; D007328:Insulin / Q000008:administration & dosage*; D008790:Metoprolol / Q000097:blood / Q000493:pharmacokinetics / Q000506:poisoning*; D008875:Middle Aged; D013997:Time Factors; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists; D000931:Antidotes; D001786:Blood Glucose; D007328:Insulin; D008790:Metoprolol; D005947:Glucose