Lipid Rescue Therapy and High-Dose insulin Euglycemic Therapy are Effective for Severe Refractory Calcium Channel Blocker Overdose: Case Report and Review of Literature

Background: High-Dose Insulin Euglycemic Therapy (HIET) and Lipid Rescue Therapy (LRT) are new alternative treatments for acute poisoning with calcium channel blockers. In this report a severely poisoned patient with verapamil and furosemide who was successfully treated with these two treatments is presented. Case report: A 27-year-old woman was brought to Mother Theresa Clinical Center in Skopje with a history of consumption of 24 grams (100 pills) sustained-release verapamil and 4 grams (10 pills) furosemide. She was alert and oriented with 60/35 mmHg blood pressure (BP), her respiratory rate was 25 breaths/min and heart rate was 40 beats/min with first degree atrioventricular (AV) block on electrocardiogram (ECG). In the first 90 minutes, she received activated charcoal, 1 liter of 0.9% saline, 60 mL of calcium chloride (CaCl2), 40 mg potassium and subsequently dopamine and 100 mg noradrenaline. However, there was no significant improvement in her hemodynamic status (BP = 70/50 mmHg) and she developed second degree AV block. Temporary pace maker was implanted. In the next one hour, the patient had stable vital signs, when she again became hypotensive (BP = 60/35 mmHg) with prolonged QRS complex (20 msec). During this period she was treated with epinephrine (9mg), atropine (2mg), isoprenalin, bicarbonate, CaCl2 and intravenous fluid. Unsuccessful conventional treatments indicated administration of HIET and LRT. Three hours later, the BP was normalized (110/75mm) and 36 hours later, all ECG disturbances disappeared. She left the Clinic without any sequels, four days later. Conclusion: LRT in addition to HIET are effective treatments for CCB overdose. LRT can be considered as a standard treatment for CCB overdose. Nevertheless, further investigations are necessary to establish the real value of these treatments.   How to cite this article: Bekjarovski NG. Lipid Rescue Therapy and High-Dose insulin Euglycemic Therapy are Effective for Severe Refractory Calcium Channel Blocker Overdose: Case Report and Review of Literature. Asia Pac J Med Toxicol 2013;2:114-6.

Keywords:

Calcium channel blockers , Fat Emulsions , Intravenous , Poisoning , Verapamil