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Journal of Medical Toxicology

, Volume 5, Issue 3, pp 139–143 | Cite as

The use of high-dose insulin-glucose euglycemia in beta-blocker overdose: A case report

  • Colin B. Page
  • L. Peter Hacket
  • Geoffrey K. Isbister
Toxicology Observations

Abstract

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 (5 g) 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.

Keywords

high-dose insulin euglycemia beta-blocker toxicity 

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Copyright information

© American College of Medical Toxicology 2009

Authors and Affiliations

  • Colin B. Page
    • 1
  • L. Peter Hacket
    • 2
  • Geoffrey K. Isbister
    • 1
    • 3
    • 4
  1. 1.Department of Clinical Toxicology and PharmacologyCalvary Mater Newcastle HospitalNewcastleAustralia
  2. 2.Department of Clinical Pharmacology and ToxicologyPath West Laboratory Medicine WAPerthAustralia
  3. 3.Discipline of Clinical Pharmacology, Faculty of HealthUniversity of NewcastleNewcastleAustralia
  4. 4.Tropical Toxicology Unit, Menzies School of Health ResearchCharles Darwin UniversityDarwinAustralia

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