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American Journal of Critical Care. 2007;16: 498-503
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Hyperinsulinemic Euglycemia Therapy for Verapamil Poisoning: A Review

By Nirav P. Patel, MD, Meredith E. Pugh, MD, Steven Goldberg, MD and Glenn Eiger, MD. Nirav P. Patel is a fellow in the Division of Pulmonary, Allergy, and Critical Care Medicine and the Center for Sleep and Respiratory Neurobiology, and Meredith E. Pugh is chief resident in the Department of Medicine, at the Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. Steven Goldberg, director of the medical intensive care unit, and Glenn Eiger, associate chairman for the department of medicine, are both members of the Division of Pulmonary and Critical Care Medicine, Albert Einstein Medical Center, in Philadelphia.

Corresponding author: Nirav P. Patel, MD, Center for Sleep and Respiratory Neurobiology, Division of Pulmonary, Allergy, and Critical Care Medicine, 3600 Spruce St, 973 Maloney Bldg, Hospital of the University of Pennsylvania, Philadelphia, PA 19104 (e-mail: nirav.patel{at}uphs.upenn.edu).

Treatment of patients with verapamil overdose remains challenging. Traditional decontamination and supportive measures with intravenous calcium and vasopressors are the mainstays in initial care. Recently, the successful use of rescue hyperinsulinemic euglycemia therapy has been described in multiple cases. Treatment resulted in improved hemodynamic parameters and increased metabolic efficiency in patients with a low-output, myocardial shock state. Information on clinical use of hyperinsulinemic euglycemia therapy in humans is limited to case reports and small case series; no controlled clinical trials have been done. Hyperinsulinemic euglycemia therapy should be considered for patients with calcium channel blocker overdose who do not respond to initial supportive therapy.


Related articles in AJCC:

Hyperinsulinemic Euglycemia Therapy for Verapamil Poisoning: Case Report
Nirav P. Patel, Meredith E. Pugh, Steven Goldberg, and Glenn Eiger
AJCC 2007 16: 520-518. [Abstract] [Full Text]  

Clinical Pearls
Mary Jo Grap
AJCC 2007 16: 432. [Full Text]  





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