Key result
High-dose insulin euglycemic therapy improves hemodynamics in a case of severe bisoprolol-induced cardiogenic shock.
Why the study?
Beta-blocker overdose can cause significant morbidity and mortality from vasopressor-resistant shock, prompting evaluation of the efficacy of early high-dose insulin therapy over conventional therapy.
Does high dose insulin euglycemic therapy improve hemodynamics in a patient with severe bisoprolol-induced cardiogenic shock?
Case Report (n=1)
Does high dose insulin euglycemic therapy improve hemodynamics in a patient with severe bisoprolol-induced cardiogenic shock?
Early initiation of high dose insulin euglycemic therapy can effectively reverse vasopressor-resistant cardiogenic shock induced by beta-blocker overdose.
High-dose insulin may stabilize hemodynamics in bisoprolol overdose; leaves open need for controlled trials before practice change.
Aims: Highlighting the efficacy of early initiation of high dose insulin therapy in Beta-blockers overdose over conventional therapy. Presentation of Case: Authors describe the successful treatment of severe bisoprolol-induced cardiogenic shock in a 74-year-old man using high dose insulin euglycemic therapy. He received intravenous bolus of 1IU/kg of actarapid insulin followed by intravenous infusion of 0.5 IU/kg/hour. The patient hemodynamic parameters improved dramatically within few hours after starting the insulin therapy. Discussion: Beta-blockers overdose can lead to significant morbidity and mortality due to the often-associated vasopressor-resistant shock. high dose insulin euglycemic therapy is a potential emerging therapy for beta-blockers toxicity with support in the literature from several animal studies, case reports and expert opinion. Conclusion: High dose insulin euglycemic therapy is a safe and effective method in reversing the hemodynamic consequences induced by beta-blockers overdose and should be used early in the treatment.
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Hussein et al. (2020) conducted a case report in Severe bisoprolol-induced cardiogenic shock (n=1). High dose insulin euglycemic therapy was evaluated on Hemodynamic parameters. High dose insulin euglycemic therapy successfully improved hemodynamic parameters within a few hours in a 74-year-old man with severe bisoprolol-induced cardiogenic shock.
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