Persistent Hyperinsulinemia Following High-Dose Insulin Therapy: A Case Report. J Med Toxicol 2020 Oct;16(4):465-469
Date
07/14/2020Pubmed ID
32656624Pubmed Central ID
PMC7554282DOI
10.1007/s13181-020-00796-2Scopus ID
2-s2.0-85087769151 (requires institutional sign-in at Scopus site) 10 CitationsAbstract
INTRODUCTION: Overdoses of beta-adrenergic antagonists and calcium channel antagonists represent an uncommonly encountered but highly morbid clinical presentation. Potential therapies include fluids, calcium salts, vasopressors, intravenous lipid emulsion, methylene blue, and high-dose insulin. Although high-dose insulin is commonly used, the kinetics of insulin under these conditions are unknown.
CASE REPORT: We present a case of a 51-year-old male who sustained a life-threatening overdose after ingesting approximately 40 tablets of a mixture of amlodipine 5 mg and metoprolol tartrate 25 mg. Due to severe bradycardia and hypotension, he was started on high-dose insulin (HDI) therapy; this was augmented with epinephrine. Despite the degree of his initial shock state, he ultimately recovered, and HDI was discontinued. Insulin was infused for a total of approximately 37 hours, most of which was dosed at 10 U/kg/hour; following discontinuation, serial serum insulin levels were drawn and remained at supraphysiologic levels for at least 24 hours and well above reference range for multiple days thereafter.
CONCLUSION: The kinetics of insulin following discontinuation of high-dose insulin therapy are largely unknown, but supraphysiologic insulin levels persist for some time following therapy; this may allow for simple discontinuation rather than titration of insulin at the end of therapy. Dextrose replacement is frequently needed; although the duration is often difficult to predict, prolonged infusions may not be necessary.
Author List
Corcoran JN, Jacoby KJ, Olives TD, Bangh SA, Cole JBAuthor
Justin N. Corcoran MD Assistant Professor in the Emergency Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Adrenergic beta-1 Receptor AntagonistsAmlodipine
Bradycardia
Calcium Channel Blockers
Drug Administration Schedule
Drug Overdose
Humans
Hyperinsulinism
Hypoglycemic Agents
Hypotension
Infusions, Intravenous
Insulin
Male
Metoprolol
Middle Aged
Suicide, Attempted
