title: Cardiotoxic overdose treated with intravenous fat emulsion and high-dose insulin in the setting of hypertrophic cardiomyopathy.
abstract: High-dose insulin (HDI) and intravenous fat emulsion (IFE) are used in overdoses, although rarely combined. To our knowledge, IFE therapy has not been reported in overdoses of diltiazem, metoprolol and amiodarone. We report a severe overdose of these drugs treated with HDI and IFE in a patient with hypertrophic cardiomyopathy (HCM). We also discuss the potential clinical implications of the inotropic effects of HDI in the setting of HCM and the use and efficacy of IFE in this overdose.
authors.affiliation: Clinical Toxicology Service and Department of Emergency Medicine, Regions Hospital, 640 Jackson Street, St. Paul, MN 55101, USA. samuel.j.stellpflug@healthpartners.com
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Stellpflug
authors.forename: Sandy J
authors.initials: SJ
authors.lastname: Fritzlar
authors.forename: Jon B
authors.initials: JB
authors.lastname: Cole
authors.forename: Kristin M
authors.initials: KM
authors.lastname: Engebretsen
authors.forename: Joel S
authors.initials: JS
authors.lastname: Holger
mesh_terms: D058671:Adrenergic beta-1 Receptor Antagonists / Q000506:poisoning*; D000328:Adult; D000638:Amiodarone / Q000506:poisoning; D002312:Cardiomyopathy, Hypertrophic; D054715:Cardiotoxins / Q000506:poisoning*; D004110:Diltiazem / Q000506:poisoning; D004305:Dose-Response Relationship, Drug; D062787:Drug Overdose / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005217:Fat Emulsions, Intravenous / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D008790:Metoprolol / Q000506:poisoning; D013406:Suicide, Attempted; D016896:Treatment Outcome
chemical_list: D058671:Adrenergic beta-1 Receptor Antagonists; D054715:Cardiotoxins; D005217:Fat Emulsions, Intravenous; D007004:Hypoglycemic Agents; D007328:Insulin; D004110:Diltiazem; D008790:Metoprolol; D000638:Amiodarone