The Use of High-dose Insulin Infusion and Lipid Emulsion Therapy in Concurrent Beta-blocker and Calcium Channel Blocker Overdose

Patients admitted with the presumed coingestion of beta-blockers (BBs) and calcium channel blockers (CCBs) should be initially managed in accordance with standardized resuscitation protocols (the airway, breathing, and circulation (ABC) approach). Additionally, more specific interventions should be...

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Bibliographic Details
Published in:Curēus (Palo Alto, CA) CA), 2018-11, Vol.10 (11), p.e3534
Main Authors: Lashari, Bilal H, Minalyan, Artem, Khan, Waqas, Naglak, Mary, Ward, William
Format: Article
Language:English
Subjects:
Anesthesiology
Blood pressure
Cardiac arrhythmia
Cardiology
Case reports
Dopamine
Drug dosages
Drug overdose
Emergency Medicine
Fatty acids
Heart rate
Hypertension
Hypoglycemia
Insulin
Lipids
Metabolism
Patients
Toxicity
Vital signs
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Summary:Patients admitted with the presumed coingestion of beta-blockers (BBs) and calcium channel blockers (CCBs) should be initially managed in accordance with standardized resuscitation protocols (the airway, breathing, and circulation (ABC) approach). Additionally, more specific interventions should be promptly attempted. Intravenous glucagon and calcium salts have long been used in the treatment of BB and CCB toxicities. We present a case of a severe, concurrent BB and CCB toxicity resulting in cardiovascular collapse refractory to vasopressors. The administration of high-dose insulin (HDI) and lipid emulsion therapy (LET) resulted in a significant improvement in hemodynamics with an overall favorable outcome in the patient.
ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.3534