A randomized controlled study comparing high-dose insulin to vasopressors or combination therapy in a porcine model of refractory propranolol-induced cardiogenic shock

Katzung, Katherine G.; Leroy, J; Boley, Sean P; Stellpflug, Samuel J.; Holger, Joel S.; Engebretsen, Kristin M.

doi:10.1080/15563650.2019.1580372

Cited by 18 publications

(15 citation statements)

References 23 publications

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“…The authors concluded that higher insulin doses may be required in the presence of vasopressors to overcome increased SVR and decreased cardiac output 21 . The second study found that patients treated with norepinephrine after maximizing high-dose insulin therapy had improved brain tissue oxygenation compared to HIET alone 22 and that patients with profound hypotension (<55mmHg) could benefit from vasopressors after maximizing HIET.…”

Section: Discussionmentioning

confidence: 99%

“…Beta-blocker overdose is often used in experimental models to extrapolate data which can then be applied to clinical CCB and beta-blocker toxicities as both drug classes result in blockade of calcium flux through the L-type calcium channels 20 . Two experimental porcine models evaluated the use of vasopressors and HIET in propranolol-induced cardiogenic shock 21,22 . The first study found that pigs treated with insulin and dextrose had a consistent improvement in cardiac output over the duration of treatment compared with the pigs treated with vasopressors alone, which had a progressive worsening of cardiac output 21 .…”

Section: Discussionmentioning

confidence: 99%

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Hyperinsulinemia/euglycemia therapy (HIET) for the management of severe amlodipine toxicosis in a cat

Tinsman¹,

Bellis²

2021

Preprint

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Hyperinsulinemia/euglycemia therapy (HIET) for the management of severe amlodipine toxicosis in a cat

Tinsman¹,

Bellis²

2021

Preprint

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“…However, case series in which high-dose insulin euglycemic therapy is more effective constitute the majority (1,14,15). In another study, it was reported that the combined use of ketocalamine and high-dose insulin euglycemic therapy is more effective (16). Such patients may also benefit from the treatment of calcium salts (7).…”

Section: Figure 1 Drug Particles Visible In the Stomach Lumen On The Patient's Abdominal Tomographymentioning

confidence: 99%

A Case of High Dose Metoprolol Poisoning; Case Report and Literature Review

Ocak¹,

Çetinkaya

Kesim

2021

İJCMBS

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β-Blockers are prescribed by physicians for many medical reasons (hypertension, long-term prophylaxis of angina pectoris, myocardial infarction, stable heart failure treatment, cardiac arrhythmias, etc.). Although cases of β-blocker poisoning have a low rate of 0.9% among all poisoning cases, they have a high mortality rate. In β-blocker poisoning with high lipid solubility; seizures, respiratory depression, coma, resistant bradycardia-hypotension and shock may occur. Metoprolol, a type of β-blocker, is a selective β1-adrenoceptor antagonist with sympathomimetic effect. It is also reported that metoprolol is the 2nd most commonly prescribed β-blocker after bisoprolol all over the world. This article aims to present a case who took high-dose metoprolol for suicidal purposes and to examine metoprolol poisoning and its treatment in the light of current literature.

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“…Clinically, amlodipine is administered as an oral formulation. In order to directly control the amount of circulating amlodipine in our study, we made the decision to administer it intravenously (IV); this has been successful in previous toxicity models using other drugs [16][17][18][19]21]. The goal of this approach was to mimic the oral absorption of the drug, while avoiding the unpredictable nature of gastrointestinal absorption and the need to measure serum drug concentrations.…”

Section: Amlodipine Preparationmentioning

confidence: 99%

“…Response to a brief pinch of the toe was used to assess for adequate sedation. Once sedated, animals were instrumented in a fashion similar to several previous studies undertaken by this group [16][17][18]21]. A tracheostomy was performed and the animal was placed on a ventilator.…”

Section: Instrumentationmentioning

confidence: 99%

Development and Feasibility of a Porcine Model of Amlodipine Toxicity

et al. 2019

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Introduction Toxicity related to calcium-channel blockers remains a significant cause of morbidity and mortality. Amlodipineinduced shock is unique in that its mechanism of action is thought to occur in part via the release of nitric oxide (NO) in the peripheral vasculature. Specific therapeutic interventions, including methylene blue (an NO scavenger), have been suggested, but efficacy studies are severely limited. To facilitate a larger porcine study into the effect of various interventions on amlodipine toxicity, we undertook this model development and feasibility study. Methods Intravenous amlodipine was prepared by dissolving commercially obtained amlodipine tablets in dimethylsulfoxide. The concentration of the drug was verified using ultraviolet spectroscopy. We administered this solution to three animals in order to determine a toxic dose, capable of facilitating a two-arm study of amlodipine toxicity. ResultsThe first pig died rapidly after the bolus infusion. The second pig developed mild toxicity, but the dissolution of the plastic tubing by the solvent and subsequent leakage limited the interpretability of the result. The third animal developed expected toxicity with an infusion rate between 2.0 and 5.5 mg/kg/h. Conclusion This study demonstrates a potentially repeatable model of amlodipine-induced toxic shock using intravenous administration of amlodipine and several methodological considerations for researchers undertaking similar work.

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A randomized controlled study comparing high-dose insulin to vasopressors or combination therapy in a porcine model of refractory propranolol-induced cardiogenic shock

Cited by 18 publications

References 23 publications

Hyperinsulinemia/euglycemia therapy (HIET) for the management of severe amlodipine toxicosis in a cat

Hyperinsulinemia/euglycemia therapy (HIET) for the management of severe amlodipine toxicosis in a cat

A Case of High Dose Metoprolol Poisoning; Case Report and Literature Review

Development and Feasibility of a Porcine Model of Amlodipine Toxicity

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