title: Hyperinsulinemia euglycemia therapy for calcium channel blocker overdose: a case report.
abstract: We report the case of a patient with calcium channel blocker toxicity who was treated successfully with hyperinsulinemia euglycemia therapy, without prior use of vasopressors. The patient was a 60-year-old man with schizoaffective disorder who presented with severe hemodynamic compromise after an intentional overdose of 5,400 mg of extended-release diltiazem. He had been admitted to the hospital twice before for attempted suicide with diltiazem and nifedipine, respectively. During the previous admissions, conventional treatments were used, and complications included hemodynamic compromise, ischemic bowel requiring ileostomy, and a prolonged hospital stay. During the current admission, the patient's clinical condition failed to improve after treatment with charcoal, fluid resuscitation, calcium, and glucagon. Eight hours after admission, hyperinsulinemia euglycemia therapy was initiated; 3 hours later, the patient's hemodynamic status showed sustained improvement. His bradycardia and hypotension resolved without cardiac pacing or vasopressors. Hyperinsulinemia euglycemia therapy is a potentially life-saving treatment for calcium channel blocker toxicity. We suggest that such therapy should be considered early, in conjunction with conventional therapy, for the treatment of calcium channel blocker overdose in patients not responding to initial treatment.
authors.affiliation: Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois 62702, USA. anudr28@gmail.com
authors.forename: Anushree
authors.initials: A
authors.lastname: Agarwal
authors.forename: Siegfried W
authors.initials: SW
authors.lastname: Yu
authors.forename: Abdul
authors.initials: A
authors.lastname: Rehman
authors.forename: Joseph Q
authors.initials: JQ
authors.lastname: Henkle
mesh_terms: D001794:Blood Pressure / Q000187:drug effects; D001919:Bradycardia / Q000139:chemically induced / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D002121:Calcium Channel Blockers / Q000506:poisoning*; D002318:Cardiovascular Diseases / Q000150:complications / Q000188:drug therapy; D004110:Diltiazem / Q000506:poisoning*; D015309:Glucose Clamp Technique; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006946:Hyperinsulinism; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007022:Hypotension / Q000139:chemically induced / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011041:Poisoning / Q000188:drug therapy; D063487:Prescription Drug Misuse; D011618:Psychotic Disorders / Q000150:complications / Q000523:psychology; D013406:Suicide, Attempted; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002121:Calcium Channel Blockers; D007004:Hypoglycemic Agents; D007328:Insulin; D004110:Diltiazem