Page Colin, Hacket L Peter, Isbister Geoffrey K
Department of Clinical Toxicology and Pharmacology, Calvary Mater Newcastle Hospital, Newcastle, NSW, Australia.
J Med Toxicol. 2009 Sep;5(3):139-43. doi: 10.1007/BF03161225.
The management of life-threatening beta-blocker toxicity and its associated low cardiac output state is clinically challenging. Previous case reports and case series describe the use of hyperinsulinemia/euglycemia therapy in mono-ingestions of calcium channel blockers and mixed ingestions, including calcium channel and beta-blockers. In this case report we describe the use of high-dose insulin (10 IU/kg per hour) in a case of massive metoprolol ingestion (5g) in which hypotension was unresponsive to conventional therapies. Although the metoprolol concentrations measured in plasma were approximately 100-200 times therapeutic concentrations, the pharmacokinetics appeared to be similar to therapeutic metoprolol dosing.
危及生命的β受体阻滞剂中毒及其相关的低心排血量状态的管理在临床上具有挑战性。先前的病例报告和病例系列描述了高胰岛素血症/正常血糖疗法在钙通道阻滞剂单一摄入以及包括钙通道阻滞剂和β受体阻滞剂在内的混合摄入中的应用。在本病例报告中，我们描述了在一例大量服用美托洛尔（5克）且低血压对传统疗法无反应的病例中使用高剂量胰岛素（每小时10 IU/kg）的情况。尽管血浆中测得的美托洛尔浓度约为治疗浓度的100 - 200倍，但其药代动力学似乎与美托洛尔治疗剂量时相似。
