Department of Anaesthesia, The Shrewsbury and Telford Hospital NHS Trust, Princess Royal Hospital, Apley Castle, Telford TF1 6TF, UK.
Emerg Med J. 2010 Oct;27(10):802-3. doi: 10.1136/emj.2009.077347. Epub 2010 Jul 26.
A 62-year-old man presented 6 h after a mixed intentional overdose of dilatizem (Adizem-SR), atorvastatin, aspirin and isosorbide mononitrate. He was symptomatic, with vomiting, blurred vision and unsteady gait. Despite initial fluid resuscitation and calcium chloride, glucagon, and high-dose ionotropic therapy, his hypotension remained refractory to treatment. A bolus of high-dose insulin (Actrapid) was administered, followed by a continuous infusion. Glucose was administered to maintain a state of euglycaemia. Over the following 24 h, the patient was given 1140 units of accumulative insulin. This resulted in a significant improvement in arterial blood pressure values and metabolic indices, allowing contiguous weaning off inotropes. This case supports the use of rescue hyperinsulinaemic euglycaemia in patients with an overdose of calcium channel blockers who remain hypotensive despite standard pharmacological measures.
一位 62 岁男性在混合服用 Adizem-SR（地尔硫卓）、阿托伐他汀、阿司匹林和单硝酸异山梨酯 6 小时后出现症状。他出现了呕吐、视力模糊和步态不稳。尽管进行了初始的液体复苏以及钙氯化物、胰高血糖素和高剂量离子型治疗，但他的低血压仍然对治疗无反应。给予高剂量胰岛素（Actrapid）推注，随后进行持续输注。给予葡萄糖以维持血糖正常。在接下来的 24 小时内，患者共接受了 1140 个单位的累积胰岛素。这导致动脉血压值和代谢指标显著改善，连续停止使用正性肌力药物。该病例支持在标准药物治疗后仍存在低血压的钙通道阻滞剂过量患者中使用抢救性高胰岛素血症治疗。
