High-Dose Insulin and Intravenous Lipid Emulsion Therapy for Cardiogenic Shock Induced by Intentional Calcium-Channel Blocker and Beta-Blocker Overdose: A Case Series

In Vitro Studies Indicate Intravenous Lipid Emulsion Acts as Lipid Sink in Verapamil Poisoning

“…On the other hand, while several case reports indicate amelioration of CCB-induced cardiotoxicity by the administration of ILE [8][9][10][11], others report no benefit [12]. Hence, there are many open questions remaining such as the mechanism of ILE action, the optimal time and dose of ILE administration [9,11,13], and the interaction of ILE with other therapy being administrated. A working group charged with developing evidence-based recommendations on the use of ILE therapy in poisoning has recently been formed [14].…”

Kreislaufstillstand in besonderen Situationen

“…Therapieerfolge sind beim Einsatz von Glucagon (50-150 μg/kgKG, [357][358][359][360][361][362][363][364][365][366][367][368][369][370]), hochdosierter Insulin-und Glukosegabe [371][372][373], Lipidemulsionen [374][375][376][377], Phosphodiesterasehemmern [378,379], extrakorporaler Unterstützung und IAPB-Einsatz (intraaortale Ballonpumpe, [380][381][382] …”

Successful Treatment of Metoprolol-Induced Cardiac Arrest With High-Dose Insulin, Lipid Emulsion, and ECMO

“…Additionally, intralipid is theorized to provide fatty acid myocardial substrate and affect calcium membrane channels, increasing inotropy and chronotropy. Intralipid therapy has demonstrated hemodynamic improvement in β-adrenergic toxicity [1,25,26]. Additionally, high-dose insulin therapy is thought to increase glucose uptake into cardiac myocytes, increasing inotropic effect and cardiac output.…”

“…Previous case series have described hemodynamic benefit, with less vasopressor requirement, when using high-dose insulin in combination β-antagonist/calcium channel antagonist toxicity [27,28]. One case described successful combination of both high-dose insulin and intralipid therapy for combined β-antagonist and calcium channel antagonist toxicity, including metoprolol [26]. To the best of the authors' knowledge, this is the first reported case of a patient suffering from isolated metoprolol toxicity successfully treated with intralipid therapy, highdose insulin, and VA-ECMO.…”