Levine Michael, Boyer Edward W, Pozner Charles N, Geib Ann-Jeannette, Thomsen Todd, Mick Nathan, Thomas Stephen H
Harvard-Affiliated Emergency Medicine Residency, Brigham and Women's/Massachusetts General Hospital, Boston, MA, USA.
Crit Care Med. 2007 Sep;35(9):2071-5. doi: 10.1097/01.ccm.0000278916.04569.23.
Overdoses of calcium channel blocker agents result in hyperglycemia, primarily due to the blockade of pancreatic L-type calcium channels and insulin resistance on the cellular level. The clinical significance of the hyperglycemia in this setting has not previously been described.
This study is a retrospective review of all adult (age, >or=15 yrs) patients with a discharge diagnosis of acute verapamil or diltiazem overdose at five university-affiliated teaching hospitals. The severity of overdose was assessed by determining whether a patient met the composite end points of in-hospital mortality, the necessity for a temporary pacemaker, or the need for vasopressors. We compared the initial and peak serum glucose concentrations with hemodynamic variables between patients who did and did not meet the composite end points.
A total of 40 patients met inclusion criteria, with verapamil and diltiazem accounting for 27 of 40 (67.5%) and 13 of 40 (32.5%) of the ingestions, respectively. For those patients who did and did not meet the composite end points, the median initial serum glucose concentrations were 188 (interquartile range, 143.5-270.5) mg/dL and 129 (98.5-156.5) mg/dL, respectively (p = .0058). The median peak serum glucose concentrations for these two groups were 364 (267.5-408.5) mg/dL and 145 (107.5-160.5) mg/dL, respectively (p = .0001). The median increase in blood glucose was 71.2% for those who met composite end points vs. 0% for those who did not meet composite end points (p = .0067). Neither the change in the median heart rate nor the change in systolic blood pressure was significantly different in any group.
Serum glucose concentrations correlate directly with the severity of the calcium channel blocker intoxication. The percentage increase of the peak glucose concentration is a better predictor of severity of illness than hemodynamic derangements. If validated prospectively, serum glucose concentration alone might be an indicator to begin hyperinsulinemia-euglycemia therapy.
钙通道阻滞剂过量会导致高血糖，主要是由于胰腺L型钙通道受阻以及细胞水平的胰岛素抵抗。这种情况下高血糖的临床意义此前尚未见描述。
本研究是对五家大学附属医院中所有出院诊断为急性维拉帕米或地尔硫䓬过量的成年患者（年龄≥15岁）进行的回顾性研究。通过确定患者是否达到院内死亡、需要临时起搏器或需要血管加压药等复合终点来评估过量的严重程度。我们比较了达到和未达到复合终点的患者的初始和峰值血清葡萄糖浓度与血流动力学变量。
共有40例患者符合纳入标准，其中维拉帕米和地尔硫䓬摄入分别占40例中的27例（67.5%）和13例（32.5%）。对于达到和未达到复合终点的患者，初始血清葡萄糖浓度中位数分别为188（四分位间距，143.5 - 270.5）mg/dL和129（98.5 - 156.5）mg/dL（p = .0058）。这两组的峰值血清葡萄糖浓度中位数分别为364（267.5 - 408.5）mg/dL和145（107.5 - 160.5）mg/dL（p = .0001）。达到复合终点的患者血糖中位数升高71.2%，未达到复合终点的患者为0%（p = .0067）。任何组中心率中位数变化和收缩压变化均无显著差异。
血清葡萄糖浓度与钙通道阻滞剂中毒的严重程度直接相关。峰值葡萄糖浓度的升高百分比比血流动力学紊乱更能预测疾病严重程度。如果经过前瞻性验证，单独的血清葡萄糖浓度可能是开始高胰岛素血症 - 血糖正常化治疗的一个指标。
