Beta-Blocker Overdose Treated with Extended Duration High Dose Insulin Therapy

Poisoning and overdose of beta-blockers may be associated with significant morbidity and mortality. Management is often complicated by failure of initial first-line interventions in severe ingestions. High-dose insulin, or hyperinsulinemia/euglycemia therapy has been well described in calcium channel blocker overdose as well as mixed ingestions of calcium channeland betablocker agents. The data for the use of high-dose insulin in isolated beta blocker overdose is limited, including one human case report and a small number of animal studies. Here we report the successful treatment of a severe metoprolol overdose with a prolonged high-dose insulin infusion, for a total of 116 hours. High dose insulin therapy may be considered as a treatment option for severe beta-blocker overdose unresponsive to standard treatment.