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High Dose Insulin for Overdoses - #PHARMFAX

BB and CCB overdoses progress into cardiogenic shock.


BB and CCB overdoses progress into cardiogenic shock. BB inhibit catecholamines from binding to beta receptors, while CCB block SA and AV nodes via L-type calcium channel inhibition. CCB inhibit L type calcium channels leading inhibition of SA and AV nodes. Additionally, CCB inhibit insulin secreton of the pancreas, leading to insulin resistance and hyperglycemia.

There isn’t a proven antidote for these cardiac ingestions; therapies include fluid resuscitation, atropine, calcium, glucogon, and vasopressors. For those refractory to conventional management, high dose insulin and intralipid emulsion are considered.

HDI has been shown to improve hemodynamics for BB/CCB poisonings. Potential mechanisms include positive inotropic properties with high doses, increased cardiac intake of carbohydrates, and inhibition of of fatty acid metabolism.

There isn’t a guideline recommended practice, but a strategy used 0.5 to 1 unit/kg as a bolus, then 0.5 units/kg/hr titrated to response up to 10 units/kg/hr. Safety always first with big doses of insulin. Electrolyte abnormalities are common with HDI. Hypokalemia, hypomagnasemia, hypohoshatemia, and hypoglycemia. Replace electrolytes prior to starting HDI and stay on top of them with serial monitoring, or you’ll have a hard to repleting. CCB inhibit insulin release from the pancreas, which may cause refractory hyperglycemia. Be mindful of volume status, electrolytes, and access for concentrated electrolytes. For more #PHARMFAX in the drug bank, check out another video on my page, share the #PHARMFAX with a friend, and I hope you learned something new.

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Not medical advice. Educational purposes only. No relationships to report.

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