title: Diltiazem poisoning treated with hyperinsulinemic euglycemia therapy and intravenous lipid emulsion.
abstract: Intravenous lipid emulsion (ILE) has been proposed as a rescue therapy for severe local anesthetic drugs toxicity, but experience is limited with other lipophilic drugs. An 18-year-old healthy woman was admitted 8 h after the voluntary ingestion of sustained-release diltiazem (3600 mg), with severe hypotension refractory to fluid therapy, calcium salts, and high-dose norepinephrine (6.66 μg/kg/min). Hyperinsulinemic euglycemia therapy was initiated and shortly after was followed by a protocol of ILE (intralipid 20%, 1.5 ml/kg as bolus, followed by 0.25 ml/kg over 1h). The main finding attributed to ILE was an apparent rapid decrease in insulin resistance, despite a prolonged serum diltiazem elimination half-life. Diltiazem is a lipophilic cardiotoxic drug, which could be sequestered in an expanded plasma lipid phase. The mechanism of action of ILE is not known, including its role in insulin resistance and myocardial metabolism in calcium-channel blocker poisoning.
authors.affiliation: Department of Intensive Care, Cliniques St-Luc, 10 Avenue Hippocrate, Brussels, Belgium.
authors.forename: Virginie
authors.initials: V
authors.lastname: Montiel
authors.forename: Thierry
authors.initials: T
authors.lastname: Gougnard
authors.forename: Philippe
authors.initials: P
authors.lastname: Hantson
mesh_terms: D000293:Adolescent; D001786:Blood Glucose / Q000032:analysis*; D003131:Combined Modality Therapy; D004110:Diltiazem / Q000506:poisoning*; D004638:Emergency Treatment; D005217:Fat Emulsions, Intravenous / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D015309:Glucose Clamp Technique; D006801:Humans; D006946:Hyperinsulinism; D007328:Insulin / Q000008:administration & dosage*; D007362:Intensive Care Units; D011041:Poisoning / Q000628:therapy*; D018570:Risk Assessment; D013406:Suicide, Attempted; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D005217:Fat Emulsions, Intravenous; D007328:Insulin; D004110:Diltiazem