Insulin-Glucose as Adjunctive Therapy for Severe Calcium Channel Antagonist Poisoning

Abstract

This case series documents the clinical courses of 4 patients after verapamil overdose and 1 patient after amlodipine-atenolol overdose. All subjects had hypodynamic circulatory shock (hypotension, bradycardia, and acidosis) that was not adequately responsive to conventional treatment. After initiation of insulin-dextrose infusion, the hemodynamic status of all 5 patients stabilized and all patients survived. Plasma drug concentrations are reported for all cases and verapamil levels were extremely high in 2 patients (3710 ng/mL and 3980 ng/mL). However, because patients were not treated according to a standard protocol, each patient received variable other supportive measures and inotropic agents, and the infusion rates of insulin were variable among patients. This report provides preliminary evidence toward a larger trial of insulin-dextrose to treat hypodynamic shock from calcium channel blocker overdose.

Insulin fails to modulate the cardiac L-Type Ca 2+ current in Type II diabetes patients - a possible link to cardiac dysfunction in diabetes mellitus

“…Another important finding giving evidence for a connection between insulin signalling, I Ca,L and cardiac contractility is a series of documented clinical courses of patients with hypodynamic circulatory shock due to severe calcium channel antagonist poisoning. In these reported cases the cardiac shock was not adequately responsive to conventional treatment but after initiation of high-dose insulindextrose infusion, the haemodynamic status was stabilized [5].These known features of insulin action show the clinical relevance of our data and support the view that the proteins involved in IR signal transduction play an important part in the pathophysiology of diabetic cardiomyopathy. Elucidating the mechanisms underlying the Insulin stimulation of I Ca,L will be a highly useful tool in understanding changes in cardiac function in response to metabolic status as well as in studying cardiac pathophysiology of the metabolic syndrome.…”

“…Another important finding giving evidence for a connection between insulin signalling, I Ca,L and cardiac contractility is a series of documented clinical courses of patients with hypodynamic circulatory shock due to severe calcium channel antagonist poisoning. In these reported cases the cardiac shock was not adequately responsive to conventional treatment but after initiation of high-dose insulindextrose infusion, the haemodynamic status was stabilized [5].…”

Calcium Channel Blocker Ingestion: An Evidence-Based Consensus Guideline for Out-of-Hospital Management

“…Time-to-peak effects varied and were difficult to discern and summarize in a useful format based solely on the level 4 reports available. However, it was noted that in several instances of overdose with modified-release (SR) products, patients deteriorated clinically many hours into the course of their poisoning (46,48,63,64,101,103,105,107,109). In many such cases, there were mild clinical or electrocardiographic signs of toxicity early on, but in others these clues were either not reported or not clearly evident.…”

Survival of Verapamil-Poisoned Rats Treated with Triiodothyronine

“…This action results in depressed chronotropy and inotropy as well as peripheral vasodilation. Current therapeutic strategies for CCB toxicity have produced inconsistent clinical effects [2][3][4][5][6][7]. Thyroid hormone, however, may represent a novel therapeutic approach.…”