Why the study?
Does low-dose insulin infusion improve hemodynamics in cardiogenic shock due to combined verapamil, enalapril, and metoprolol overdose?
Does low-dose insulin infusion improve hemodynamics in cardiogenic shock due to combined verapamil, enalapril, and metoprolol overdose?
Low-dose insulin infusion may be beneficial in treating toxic cardiac depression and cardiogenic shock due to combined verapamil, enalapril, and metoprolol overdose.
Low-dose insulin was associated with rapid hemodynamic recovery in this single overdose case; hypothesis-generating and should not yet change practice.
We describe a case of severe heart failure due to the combined effect of verapamil and enalapril overdose in a patient treated regularly with metoprolol. The patient was dependent for 2 days on glucagon and dopamine infusion but remained oliguric, with deteriorating renal function. Marked improvement in all hemodynamic parameters was noted a short time after initiation of treatment with low-dose insulin infusion (1-2 units/h), which allowed the prompt withdrawal of glucagon and dopamine. We discuss the efficacy of glucose-insulin treatment in toxic cardiac depression and suggest that a low dose may be beneficial in similar cases.
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Hasin et al. (2006) studied this question.
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