What is the role of insulin therapy in the treatment of calcium channel blocker (CCB) toxicity?

Updated: Jan 04, 2021
  • Author: B Zane Horowitz, MD, FACMT; Chief Editor: Michael A Miller, MD  more...
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High-dose insulin has become accepted as therapy in calcium channel blocker (CCB) toxicity refractory to standard vasopressor therapy. [47] Hyperglycemia may occur in CCB toxicity, as calcium channel blockade inhibits insulin release. [20, 48, 48] Although no human trial has been completed, animal models and numerous case reports and case series demonstrate that high-dose insulin increases inotropy, increases intracellular glucose transport, and improves vascular dilation in CCB toxicity. [41, 49, 6, 50, 51, 52, 53, 54, 55, 56, 57, 58]

High-dose insulin therapy is administered as follows: infuse one ampule of 50% dextrose in water (D50W), then give an insulin bolus of 1 U/kg, followed by an infusion of regular insulin at 1-10 U/kg/h. Remarkably, patients with CCB toxicity who receive this therapy rarely require more supplemental dextrose than a D5W infusion. However, their serum potassium and glucose levels should be monitored every 20-30 minutes.

High-dose insulin therapy has a delayed onset of action. Consequently, it should be started soon after the patient presents with refractory hypotension.

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