High-Dose Insulin for Calcium Channel-Blocker and Beta-Blocker Poisoning in Children: Referrals to the Minnesota Regional Poison Center, 2000–2024

OBJECTIVES: High-dose insulin (HDI) is a unique therapy for beta-blocker (BB) and calcium channel-blocker (CCB) poisonings. We have examined pediatric patients with BB and/or CCB poisonings who received HDI therapy with the purpose of describing the clinical characteristics associated with these poisonings and the treatment. DESIGN: Retrospective database study using our regional, three-state poison center at the Minnesota Regional Poison Center. We identified all children treated with HDI for BB and/or CCB poisonings between the years 2000 and 2024. SETTING: Regional poison center data. PATIENTS: Pediatric patients 18 years old or younger. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We identified 36 patients with a median age of 16 years (range 7 mo-18 yr). There were 24 of 36 females, and 14 of 36 patients were poisoned with BBs, 16 of 36 patients by CCBs, and 6 of 36 patients by both drugs. The median peak insulin infusion rate was 1 unit/kg/hr (range 0.5-11 unit/kg/hr); the median insulin infusion duration was 23 hours (range 1-136 hr). The mean dextrose infusion concentration was 37% (range 5-70%). Vasopressors were used in 23 of 36 cases; median vasopressor duration was 38 hours (range 1-199 hr). Cardiac arrest occurred in 4 of 36 patients. Life support with extracorporeal membrane oxygenation (ECMO) was used in one patient. Three patients died as a result of poisoning. CONCLUSIONS: In our three-state poison center, over a 25-year period (2000-2024), HDI was predominantly used in adolescents with intentional BB/CCB overdoses. No adverse events required early discontinuation of HDI. Escalation to ECMO support was rare. More experience is needed to evaluate the safety and effectiveness of HDI in small children.