Key result
High-dose insulin is recommended as first-line treatment for CCB poisoning with cardiovascular compromise before vasopressors.
Why the study?
High-dose insulin therapy with glucose supplementation has been suggested for calcium-channel blocker poisonings, and published evidence was reviewed to evaluate its effectiveness and safety.
Does high-dose insulin therapy improve outcomes in patients with calcium-channel blocker poisoning?
Does high-dose insulin therapy improve outcomes in patients with calcium-channel blocker poisoning?
High-dose insulin therapy should be considered as a first-line treatment for calcium-channel blocker toxicity with cardiovascular compromise, prior to the use of vasopressors or inotropes.
May support HDI in CCB poisoning; leaves open need for randomized trials before practice change.
High-dose insulin (HDI) therapy with adapted glucose supplementation to maintain euglycaemia has been suggested to treat calcium-channel blocker (CCB) poisonings. Its underlying mechanisms of action are now well documented. We present a narrative review of the published experimental studies, case reports and experts' opinions to support the effectiveness and safety of HDI in the treatment of CCB poisoning. Our review strongly encourages the use of HDI as first-line therapy in CCB-poisoned patients in the presence of cardiovascular compromise, especially if cardiac function impairment has been diagnosed, before, but without delaying, the administration of vasopressors/inotropic drugs.
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Bruno Mégarbane (2023) conducted a review in Calcium-channel blocker poisoning. High-dose insulin (HDI) therapy vs. Vasopressors/inotropic drugs was evaluated. High-dose insulin therapy is recommended as first-line treatment for calcium-channel blocker poisoning with cardiovascular compromise, prior to the administration of vasopressors or inotropes.
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