Lipid Rescue Therapy and High-Dose insulin Euglycemic Therapy are Effective for Severe Refractory Calcium Channel Blocker Overdose: Case Report and Review of Literature
author
Abstract:
Background: High-Dose Insulin Euglycemic Therapy (HIET) and Lipid Rescue Therapy (LRT) are new alternative treatments for acute poisoning with calcium channel blockers. In this report a severely poisoned patient with verapamil and furosemide who was successfully treated with these two treatments is presented. Case report: A 27-year-old woman was brought to “Mother Theresa” Clinical Center in Skopje with a history of consumption of 24 grams (100 pills) sustained-release verapamil and 4 grams (10 pills) furosemide. She was alert and oriented with 60/35 mmHg blood pressure (BP), her respiratory rate was 25 breaths/min and heart rate was 40 beats/min with first degree atrioventricular (AV) block on electrocardiogram (ECG). In the first 90 minutes, she received activated charcoal, 1 liter of 0.9% saline, 60 mL of calcium chloride (CaCl2), 40 mg potassium and subsequently dopamine and 100 mg noradrenaline. However, there was no significant improvement in her hemodynamic status (BP = 70/50 mmHg) and she developed second degree AV block. Temporary pace maker was implanted. In the next one hour, the patient had stable vital signs, when she again became hypotensive (BP = 60/35 mmHg) with prolonged QRS complex (20 msec). During this period she was treated with epinephrine (9mg), atropine (2mg), isoprenalin, bicarbonate, CaCl2 and intravenous fluid. Unsuccessful conventional treatments indicated administration of HIET and LRT. Three hours later, the BP was normalized (110/75mm) and 36 hours later, all ECG disturbances disappeared. She left the Clinic without any sequels, four days later. Conclusion: LRT in addition to HIET are effective treatments for CCB overdose. LRT can be considered as a standard treatment for CCB overdose. Nevertheless, further investigations are necessary to establish the real value of these treatments. How to cite this article: Bekjarovski NG. Lipid Rescue Therapy and High-Dose insulin Euglycemic Therapy are Effective for Severe Refractory Calcium Channel Blocker Overdose: Case Report and Review of Literature. Asia Pac J Med Toxicol 2013;2:114-6.
similar resources
Severe Overdose of Calcium Channel Blocker and Successful Management: A Literature Review and Case Report
full text
Calcium Channel Blocker (amlodepine) Poisioning Managed by Hyperinsulinemic Euglycemic Therapy--a Case Report and Review of Literature
Amlodepine poisioning is rare. Amlodepine toxicity presents as hypotension, pulmonary oedema both cardiogenic and non-cardiogenic. Standard approaches to the management of calcium channel blocker overdoses, including fluid resuscitation, gut decontamination, administration of calcium, as well as supportive care, are often ineffective. pWe report a case of amlodepine poisioning with acute respir...
full textβ-Blocker and Calcium Channel Blocker Poisoning: High-Dose Insulin/Glucose Therapy.
Overdoses of β-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...
full textHigh-dose insulin therapy in beta-blocker and calcium channel-blocker poisoning.
INTRODUCTION. High-dose insulin therapy, along with glucose supplementation, has emerged as an effective treatment for severe beta-blocker and calcium channel-blocker poisoning. We review the experimental data and clinical experience that suggests high-dose insulin is superior to conventional therapies for these poisonings. PRESENTATION AND GENERAL MANAGEMENT. Hypotension, bradycardia, decrease...
full textA multifaceted approach to calcium channel blocker overdose: a case report and literature review
Calcium channel blocker toxicity can be devastating. Initial therapy with fluid, calcium, and adrenoreceptor agonists should be prompt and novel therapies can be added if no response. Determining cardiogenic shock versus vasoplegia with echocardiogram or other hemodynamic monitoring may guide treatment options.
full textHyperinsulinemic Euglycemia and Intravenous Lipid Emulsion Treatments for Calcium Channel Blocker and Beta Blocker Poisoning: A Report of Two Cases
Poisoning with calcium channel blockers and beta blockers are associated with high mortality and morbidity rates, especially in children. Treatment of poisoning with these drugs includes administration of atropine, glucagon, calcium and inotropic agents as clinically needed; and newer approaches like hyperinsulinemic euglycemia and intravenous lipid emulsion therapies. We herein present two ref...
full textMy Resources
Journal title
volume 2 issue 3
pages 114- 116
publication date 2013-09-01
By following a journal you will be notified via email when a new issue of this journal is published.
Hosted on Doprax cloud platform doprax.com
copyright © 2015-2023