Insulin-glucose as adjunctive therapy for severe calcium channel antagonist poisoning

Case Report: This case series documents the clinical courses of 4 patients after verapamil overdose and 1 patient after amlodipine-atenolol overdose. All subjects had hypodynamic circulatory shock (hypotension, bradycardia, a nd acidosis) that was not adequately responsive to conventional treatment. After initiation of insulin-dextrose infusion, the hemodynamic status of al l 5 patients stabilized and all patients survived, Plasma drug concentratio ns are reported for all cases and verapamil levels were extremely high in 2 patients (3710 ng/mL and 3980 ng/mL), However, because patients were not t reated according to a standard protocol, each patient received variable oth er supportive measures and inotropic agents, and the infusion rates of insu lin were variable among patients. This report provides preliminary evidence toward a larger trial of insulin-dextrose to treat hypodynamic shock from calcium channel blocker overdose.