High-Dose Insulin for Toxin Induced Cardiogenic Shock: Experience at a New High and Overview of the Evidence.
| Title: | High-Dose Insulin for Toxin Induced Cardiogenic Shock: Experience at a New High and Overview of the Evidence. |
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| Authors: | Chad T; Adult Intensive Care Unit, St. Mary's Hospital, Imperial College Healthcare National Health Service Trust, London, United Kingdom.; Ulla M; Adult Intensive Care Unit, St. Mary's Hospital, Imperial College Healthcare National Health Service Trust, London, United Kingdom.; Garnelo Rey V; Adult Intensive Care Unit, St. Mary's Hospital, Imperial College Healthcare National Health Service Trust, London, United Kingdom.; Gómez C; Adult Intensive Care Unit, St. Mary's Hospital, Imperial College Healthcare National Health Service Trust, London, United Kingdom. |
| Source: | The Journal of emergency medicine [J Emerg Med] 2020 Feb; Vol. 58 (2), pp. 317-323. Date of Electronic Publication: 2019 Nov 22. |
| Publication Type: | Case Reports; Journal Article |
| Language: | English |
| Journal Info: | Publisher: Elsevier Country of Publication: United States NLM ID: 8412174 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 0736-4679 (Print) Linking ISSN: 07364679 NLM ISO Abbreviation: J Emerg Med Subsets: MEDLINE |
| Imprint Name(s): | Publication: - : New York : Elsevier; Original Publication: New York : Pergamon Press, c1983- |
| MeSH Terms: | Hypoglycemic Agents/*administration & dosage ; Insulin/*administration & dosage ; Shock, Cardiogenic/*chemically induced ; Shock, Cardiogenic/*drug therapy; Aged ; Emergency Service, Hospital ; Humans ; Infusions, Intravenous ; Male |
| Abstract: | Background: High-dose insulin therapy is an effective treatment for cardiogenic shock caused by the overdose of particular medications. Other treatment options are usually of limited benefit. Consensus suggests that early initiation improves efficacy. No ceiling effect has been established at doses in the general range of 0.5-10 units/kg/hour.; Case Report: A 79-year-old man presented in cardiogenic shock after an intentional overdose of numerous cardioactive medications 10 days after experiencing myocardial infarction. A high-dose insulin infusion was commenced. This was titrated up to a maximum of 20 units/kg/hour (1600 units/hour) and sustained for 32 h (61,334 units total). Minimal adverse events were seen despite this exceptional infusion rate (3 episodes of hypoglycemia and 2 episodes of hypokalemia). Concurrent catecholamine support was used, and cardiovascular function was maintained until all support was withdrawn 5 days after admission. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians are pivotal to the successful initiation/up-titration of high-dose insulin therapy. They must balance the potential for treatment failure with other treatment options, mitigate against adverse events in the initial phase of therapy, and coordinate care between other hospital specialties. This case shows that the relative safety and efficacy was extended to an infusion rate of 20 units/kg/hour, the highest recorded in the published literature. This information may help guide treatment of similar cases in the future.; (Copyright © 2019 Elsevier Inc. All rights reserved.) |
| Contributed Indexing: | Keywords: adrenergic beta-antagonists; calcium channel blockers; cardiogenic shock; drug overdose; insulin; shock |
| Substance Nomenclature: | 0 (Hypoglycemic Agents); 0 (Insulin) |
| Entry Date(s): | Date Created: 20191126 Date Completed: 20210201 Latest Revision: 20210201 |
| Update Code: | 20260130 |
| DOI: | 10.1016/j.jemermed.2019.10.018 |
| PMID: | 31761461 |
| Database: | MEDLINE |
Case Reports; Journal Article