Diltiazem overdose: a role for high-dose insulin.
A 62-year-old man presented 6 h after a mixed intentional overdose of dilatizem (Adizem-SR), atorvastatin, aspirin and isosorbide mononitrate. He was symptomatic, with vomiting, blurred vision and unsteady gait. Despite initial fluid resuscitation and calcium chloride, glucagon, and high-dose ionotropic therapy, his hypotension remained refractory to treatment. A bolus of high-dose insulin (Actrapid) was administered, followed by a continuous infusion. Glucose was administered to maintain a state of euglycaemia. Over the following 24 h, the patient was given 1140 units of accumulative insulin. This resulted in a significant improvement in arterial blood pressure values and metabolic indices, allowing contiguous weaning off inotropes. This case supports the use of rescue hyperinsulinaemic euglycaemia in patients with an overdose of calcium channel blockers who remain hypotensive despite standard pharmacological measures.
Abeysinghe
Neil
N
Department of Anaesthesia, The Shrewsbury and Telford Hospital NHS Trust, Princess Royal Hospital, Apley Castle, Telford TF1 6TF, UK. abeysingN@aol.com
Aston
Jessica
J
Polouse
Sonia
S
D000924:Anticholesteremic Agents / Q000506:poisoning; D000069059:Atorvastatin; D002121:Calcium Channel Blockers / Q000506:poisoning*; D004110:Diltiazem / Q000506:poisoning*; D005440:Fluid Therapy; D006538:Heptanoic Acids / Q000506:poisoning; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007022:Hypotension / Q000139:chemically induced / Q000188:drug therapy* / Q000628:therapy; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D063487:Prescription Drug Misuse; D011758:Pyrroles / Q000506:poisoning
D000924:Anticholesteremic Agents; D002121:Calcium Channel Blockers; D006538:Heptanoic Acids; D007004:Hypoglycemic Agents; D007328:Insulin; D011758:Pyrroles; D000069059:Atorvastatin; D004110:Diltiazem