Agarwal Anushree, Yu Siegfried W, Rehman Abdul, Henkle Joseph Q
Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois 62702, USA.
Tex Heart Inst J. 2012;39(4):575-8.
We report the case of a patient with calcium channel blocker toxicity who was treated successfully with hyperinsulinemia euglycemia therapy, without prior use of vasopressors. The patient was a 60-year-old man with schizoaffective disorder who presented with severe hemodynamic compromise after an intentional overdose of 5,400 mg of extended-release diltiazem. He had been admitted to the hospital twice before for attempted suicide with diltiazem and nifedipine, respectively. During the previous admissions, conventional treatments were used, and complications included hemodynamic compromise, ischemic bowel requiring ileostomy, and a prolonged hospital stay. During the current admission, the patient's clinical condition failed to improve after treatment with charcoal, fluid resuscitation, calcium, and glucagon. Eight hours after admission, hyperinsulinemia euglycemia therapy was initiated; 3 hours later, the patient's hemodynamic status showed sustained improvement. His bradycardia and hypotension resolved without cardiac pacing or vasopressors. Hyperinsulinemia euglycemia therapy is a potentially life-saving treatment for calcium channel blocker toxicity. We suggest that such therapy should be considered early, in conjunction with conventional therapy, for the treatment of calcium channel blocker overdose in patients not responding to initial treatment.
我们报告了一例钙通道阻滞剂中毒患者，该患者在未预先使用血管升压药的情况下，通过高胰岛素正常血糖疗法成功治愈。患者为一名60岁患有分裂情感障碍的男性，在故意过量服用5400毫克缓释地尔硫䓬后出现严重的血流动力学损害。他此前曾分别因试图服用地尔硫䓬和硝苯地平自杀而两次入院。在前两次住院期间，采用了传统治疗方法，并发症包括血流动力学损害、需要进行回肠造口术的缺血性肠病以及住院时间延长。在本次住院期间，患者在接受活性炭、液体复苏、钙剂和胰高血糖素治疗后，临床状况未见改善。入院8小时后，开始采用高胰岛素正常血糖疗法；3小时后，患者的血流动力学状态持续改善。他的心动过缓和低血压得以缓解，无需心脏起搏或使用血管升压药。高胰岛素正常血糖疗法是治疗钙通道阻滞剂中毒的一种潜在的挽救生命的疗法。我们建议，对于初始治疗无反应的钙通道阻滞剂过量患者，应在早期结合传统疗法考虑采用这种疗法进行治疗。
