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🐱 High Dose Insulin - Euglycemia Therapy - #MEDSHED
👀 BB and CCB overdoses progress into cardiogenic shock. BB inhibit catecholamines from binding to beta receptors, while CCB block SA and AV nodes via L-type calcium channel inhibition. CCB inhibit L type calcium channels leading inhibition of SA and AV nodes. Additionally, CCB inhibit insulin secretion of the pancreas, leading to insulin resistance and hyperglycemia.
🐱🐉 There isn’t a proven antidote for these cardiac ingestions; therapies include fluid resuscitation, atropine, calcium, glucagon, and vasopressors. For those refractory to conventional management, high dose insulin and intralipid emulsion are considered.
HDI has been shown to improve hemodynamics for BB/CCB poisonings. Potential mechanisms include positive inotropic properties with high doses, increased cardiac intake of carbohydrates, and inhibition of of fatty acid metabolism.
🎂 There isn’t a guideline recommended practice, but a strategy used 0.5 to 1 unit/kg as a bolus, then 0.5 units/kg/hr titrated to response up to 10 units/kg/hr. Safety always first with big doses of insulin. Electrolyte abnormalities are common with HDI. Hypokalemia, hypomagnesemia, hypophosphatemia, and hypoglycemia.
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Not medical advice. Educational purposes only. No relationships to report.
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