High dose insulin therapy, an evidence based approach to beta blocker/calcium channel blocker toxicity

Woodward, Christina; Pourmand, Ali; Mazer‐Amirshahi, Maryann

doi:10.1186/2008-2231-22-36

Cited by 44 publications

(60 citation statements)

References 33 publications

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“…Its main mechanism lies in its inotropic effect, thought to result from increased intracellular glucose transportation within cardiac muscle. In particular, this inotropic effect occurs without increasing myocardial oxygen demand [10].…”

Section: Post-scenario Didacticsmentioning

confidence: 98%

Propranolol Overdose: An Emergency Medicine Simulation Scenario

Whalen¹,

Angus²,

Dubrowski³

2014

Cureus

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Section: Post-scenario Didacticsmentioning

confidence: 98%

Propranolol Overdose: An Emergency Medicine Simulation Scenario

Whalen¹,

Angus²,

Dubrowski³

2014

Cureus

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“…Intensive insulin therapy is also now an established treatment for the management of profound cardiogenic shock secondary to β‐blocker and calcium channel blocker overdose . More recently, the safety, haemodynamic effects and impact on catecholamine dosage of high‐dose insulin therapy in patients with inotropic resistant myocardial dysfunction have been demonstrated in critically ill patients without β‐blocker and calcium channel blocker overdose .…”

Section: Insulin Therapy and Critical Carementioning

confidence: 99%

Insulin therapy in organ donation and transplantation

Shapey

Summers

Yiannoullou

et al. 2019

Diabetes Obesity Metabolism

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Hyperglycaemia is common in hospitalized individuals, and is often caused by physiological stress associated with critical illness or major surgery. Insulin therapy is an established treatment for hyperglycaemia and acute hyperkalaemia, and has also been used for myocardial dysfunction resistant to inotropic support. Insulin is commonly used in both organ donors and transplant recipients for hyperglycaemia, but the underlying knowledge base supporting its use remains limited. Insulin therapy plays an important yet poorly understood role in both organ donation and transplantation. Tight glycaemic control has been extensively studied in critical care over the past 15 years; however, this has not yet translated into the field of transplantation, where patients are more unwell and where improved outcomes remain an ongoing challenge. Insulin therapy and optimization of glycaemic control represent important areas for future hypothesis‐driven research into organ donation and transplantation, such as amelioration of ischaemia‐reperfusion injury, rejection and infection.

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“…Using a pharmacological intervention properly requires you to know: (1) which patients will benefit, (2) proper dosing, (3) when to start and stop the treatment, (4) adverse effects, (5) monitoring parameters, and (6) how the intervention will be affected by other drugs or therapies that are being used.…”

Section: Administering and Monitoring High-dose Insulin/glucosementioning

confidence: 99%

“…37 No guidelines are available for how to taper and discontinue the infusion. 2,3 Serum glucose levels should be monitored closely after the infusion has stopped: published reports indicate that insulin levels may remain elevated for 24 hours after high-dose insulin therapy has been stopped. 3,34 The decision to use highdose insulin/glucose as the primary therapy or as an adjunct must be made on a case by case basis.…”

Section: Administering and Monitoring High-dose Insulin/glucosementioning

confidence: 99%

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β-Blocker and Calcium Channel Blocker Poisoning: High-Dose Insulin/Glucose Therapy

Bartlett

2016

Critical Care Nurse

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Overdoses of b-blockers and calcium channel blockers can produce significant morbidity and mortality, and conventional therapies often do not work as treatments for these poisonings. High-dose insulin/glucose therapy has been successful in reversing the cardiotoxic effects of these drugs in cases where the standard therapies have failed, and it appears to be relatively safe. Many successes have been well documented, but the clinical experience consists of case reports, the mechanisms of action are not completely understood, and guidelines for use of the therapy are empirically derived and not standardized. Regardless of these limitations, high-dose insulin/glucose therapy can be effective, it is often recommended by clinical toxicologists and poison control centers, and critical care nurses should be familiar with when and how the therapy is used. b-Blocker and Calcium Channel Blocker Poisoning: High-Dose Insulin/ Glucose Therapy H igh-dose insulin/glucose therapy, which is also called hyperinsulinemic/euglycemic therapy or insulin-dextrose therapy, has received considerable attention as a treatment for overdoses of b-blockers and calcium channel blockers that are refractory to conventional therapies. Clinical experience using high-dose insulin/glucose to treat cardiotoxic poisonings in humans dates to 1999, 1 and animal experiments before that time provided the theoretical background and the impetus for extension of its use to treat calcium channel blocker overdoses and then b-blocker overdoses.Despite many articles in medical publications and 15 years of clinical experience with its use, questions remain about how high-dose insulin/glucose therapy works and when and for whom this therapy should be applied. In addition, the dosing guidelines are not standardized. However, high-dose insulin/ glucose therapy is commonly used and often recommended for treating b-blocker and calcium channel blocker poisoning, and critical care nurses should be familiar with the therapy.

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High dose insulin therapy, an evidence based approach to beta blocker/calcium channel blocker toxicity

Cited by 44 publications

References 33 publications

Propranolol Overdose: An Emergency Medicine Simulation Scenario

Propranolol Overdose: An Emergency Medicine Simulation Scenario

Insulin therapy in organ donation and transplantation

β-Blocker and Calcium Channel Blocker Poisoning: High-Dose Insulin/Glucose Therapy

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