Efficacy of insulin therapy in severe poisoning with calcium channel blockers

Abstract

Introduction. In recent years, there has been an increased number of poisoning with drugs that mainly affect the cardiovascular system, including calcium channel blockers. According to foreign literature, insulin therapy is an effective and safe method of treating patients with severe poisoning with calcium channel blockers.Aim. To demonstrate the efficacy of high-dose insulin in severe poisoning with calcium channel blockers.Results. Patient T., 37 years old, took 1000 tablets of nifedipine for suicide 4-6 hours before admission to the hospital. In connection with the development of refractory shock and the ineffectiveness of basic therapy (the intravenous administration of 0.9% sodium chloride solution, calcium chloride (saturated dose), vasopressor/inotropic agents), a decision was made to administer high doses of insulin. After a bolus intravenous injection of insulin, the rate of its intravenous administration was 0.5 U/kg/h and, due to the lack of hemodynamic effect, it was gradually increased in increments of 1–2 U/kg/h at every 15–30 minutes up to a maximum of 8 U/kg/h with constant monitoring of glucose and potassium levels in the blood. As a result, the target hemodynamic parameters were achieved. Then the insulin infusion rate was gradually reduced and, upon achieving hemodynamic stabilization, its administration was stopped 2 days after the start On the 9th day from the moment of hospital admission the patient was transferred from the Intensive Care Unit to the Acute Poisoning Department.Conclusions. The presented case report shows the efficacy and expediency of using the insulin therapy in the developed refractory shock due to severe poisoning with calcium channel blockers.