Diltiazem overdose: a role for high-dose insulin
- Department of Anaesthesia, The Shrewsbury and Telford Hospital NHS Trust, Princess Royal Hospital, Telford, UK
- Correspondence to Neil Abeysinghe, Department of Anaesthesia, The Shrewsbury and Telford Hospital NHS Trust, Princess Royal Hospital, Apley Castle, Telford TF1 6TF, UK; abeysingN{at}aol.com
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Contributors NA attended the patient in the ICU and wrote and revised the final manuscript and will be the guarantor for the paper. JA produced figure 1, obtained patient consent for publication and read and commented on the manuscript. wrote the initial draft of the manuscript. JA and SP attended the patient in the emergency department.
- Accepted 28 May 2009
- Published Online First 26 July 2010
Abstract
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.
Footnotes
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Competing interests None.
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Patient consent Obtained.
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Provenance and peer review Not commissioned; not externally peer reviewed.
