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American Journal of Critical Care. 2007;16: 520-518
Copyright © 2007 by the American Association of Critical-Care Nurses.
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Cases of Note features peer-reviewed case reports and case series that document clinically relevant findings from critical and high acuity care environments. Cases that illuminate clinical diagnoses and management issues in the treatment of critically and acutely ill patients and include discussion of the patient’s experience with the illness or intervention are encouraged. Proposals for future Cases of Note articles may be e-mailed to ajcc{at}aacn.org.

Hyperinsulinemic Euglycemia Therapy for Verapamil Poisoning: Case Report

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).

A 49-year-old woman was brought to the emergency department because of an intentional overdose of sustained-release verapamil along with captopril and glyburide. The estimated interval between ingestion and the time she was found was several hours. Initial findings were blood pressure 72/39 mm Hg, heart rate 32/min, and a score of 9 on the Glasgow Coma Scale. She was intubated and given intravenous fluid and vasopressor support. Decontamination with activated charcoal was instituted. Administration of dopamine and norepinephrine, atropine, sodium bicarbonate, and calcium chloride did not yield significant clinical improvement. Hyperinsulinemic euglycemia therapy was started: a bolus of regular insulin then infusions of insulin and 10% dextrose. After 24 hours of therapy, the bradycardia resolved and the patient’s hemodynamic condition stabilized with normalization of cardiac indices. On day 5 the patient was transferred to the medical unit, and on day 8 she was discharged to psychiatric care.


Related articles in AJCC:

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

Hyperinsulinemic Euglycemia Therapy for Verapamil Poisoning: A Review
Nirav P. Patel, Meredith E. Pugh, Steven Goldberg, and Glenn Eiger
AJCC 2007 16: 498-503. [Abstract] [Full Text]  



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Home page
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N. P. Patel, M. E. Pugh, S. Goldberg, and G. Eiger
Hyperinsulinemic Euglycemia Therapy for Verapamil Poisoning: A Review
Am. J. Crit. Care., September 1, 2007; 16(5): 498 - 503.
[Abstract] [Full Text] [PDF]


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