Key result
Discontinuation of high-dose insulin euglycemic therapy for severe amlodipine toxicity was followed by the unexpected development of delayed non-cardiogenic pulmonary edema.
Why the study?
Pulmonary oedema is a rare paradoxical complication following high-dose insulin euglycemic therapy withdrawal in CCB toxicity, with multiple potential confounding factors accounting for delayed onset.
Case Report (n=1)
No
This case highlights the rare risk of delayed non-cardiogenic pulmonary oedema following the cessation of high-dose insulin euglycemic therapy used for calcium channel blocker toxicity.
Monitor for delayed pulmonary oedema after HIET withdrawal in CCB toxicity; Level 5 evidence leaves open causality versus fluid overload or other confounders.
Pulmonary oedema is a rare but possible paradoxical complication following the withdrawal of high-dose insulin euglycemic therapy (HIET). In the context of calcium channel blocker (CCB) toxicity, other potential confounding factors that could account for delayed pulmonary oedema include inadvertent fluid overload from management of hypotension caused by CCB toxicity, delayed toxicodynamic effects on the pulmonary vasculature and the heart, or a previously unknown underlying cardiac dysfunction. We report a case involving a woman in her early 50s who developed a symptomatic pulmonary oedema following the discontinuation of HIET used in the management of refractory hypotension complicating a massive amlodipine intoxication. This unexpected deterioration occurred despite improved haemodynamics following HIET used in the management of amlodipine toxicity. We have reviewed this case in relation to the existing literature on delayed or paradoxical pulmonary oedema complicating CCB toxicity, to the benefit of clinical personnel managing future similar cases.
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Haq et al. (2025) conducted a case report in Amlodipine toxicity (n=1). High-dose insulin euglycemic therapy (HIET) was evaluated on Development of delayed non-cardiogenic pulmonary edema. Discontinuation of high-dose insulin euglycemic therapy for severe amlodipine toxicity was followed by the unexpected development of delayed non-cardiogenic pulmonary edema.
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