Min L, Deshpande K
Department of Critical Care Medicine, Flinders Medical Centre, Bedford Park, South Australia.
Crit Care Resusc. 2004 Mar;6(1):28-30.
A 59-year-old woman was admitted to the intensive care unit after ingesting 5.76 g of an extended release preparation of diltiazem. The patient was hypotensive and bradycardic and was treated initially with intravenous fluids, adrenaline, noradrenaline, vasopressin and standard insulin doses to maintain the blood glucose levels between 6-10 mmol/L. As the patient remained inotrope dependent the insulin dose was increased to 25 U/hr with an infusion of 50% dextrose to maintain the blood glucose levels between 6-8 mmol/L. Within 30 minutes, the mean arterial pressure increased from 65 mmHg to 80 mmHg and within 60 minutes all vasoactive agents were discontinued. A right heart catheter inserted before the increased dose of insulin revealed that the predominant haemodynamic effect of the hyperinsulinaemia-euglycaemia therapy appeared to be an increase in the peripheral vascular resistance.
一名59岁女性在摄入5.76克缓释地尔硫䓬制剂后被收入重症监护病房。患者出现低血压和心动过缓，最初接受静脉补液、肾上腺素、去甲肾上腺素、血管加压素和标准剂量胰岛素治疗，以维持血糖水平在6 - 10毫摩尔/升之间。由于患者仍依赖血管活性药物，胰岛素剂量增加至25单位/小时，并输注50%葡萄糖以维持血糖水平在6 - 8毫摩尔/升之间。30分钟内，平均动脉压从65毫米汞柱升至80毫米汞柱，60分钟内所有血管活性药物均停用。在增加胰岛素剂量之前插入的右心导管显示，高胰岛素血症 - 正常血糖疗法的主要血流动力学效应似乎是外周血管阻力增加。
