Hyperinsulinemia-euglycemia therapy: a useful tool in treating calcium channel blocker poisoning

Hyperinsulinemia-euglycemia (HIE) therapy, when initiated promptly and aggressively, may offer considerable advantages in the treatment of calcium channel blocker poisoning. Although its mechanism of action is uncertain, HIE improves the efficiency with which the poisoned myocardium uses metabolic fuel, the end result of which is improvements in inotropy and other cardiovascular parameters. Although HIE is not universally accepted, the reports included in the previous issue of Critical Care should prompt clinicians to consider HIE an appropriate therapy specifically for calcium channel blocker poisoning.