Early use of high-dose insulin euglycaemic therapy for verapamil toxicity

Christopher P Nickson and Mark Little
Med J Aust 2009; 191 (6): 350-352.

A 49-year-old man presented with verapamil toxicity complicated by hypotension and a junctional rhythm, in the context of deliberate self-poisoning with multiple drugs. The patient’s hypotension normalised following the early use of high-dose insulin euglycaemic therapy (HIET), without the need for additional vasopressors; it recurred when HIET was prematurely stopped, and again stabilised when HIET was recommenced. Consideration should be given to the early use of HIET in treating severe calcium channel blocker toxicity, rather than as a last resort after other therapies have failed. (MJA 2009; 191: 350-352)

A 49-year-old man presented to a peripheral hospital emergency department 1–1.5 h after deliberately ingesting multiple medications: verapamil (unknown amount), controlled-release morphine sulfate (20 × 30 mg), diazepam (50 × 5 mg) and tramadol (15 × 200 mg). He was a smoker with a history of depression, ethanol misuse, chronic back pain, hypertension and a previous instance of deliberate self-poisoning with multiple drugs.

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  • Christopher P Nickson1
  • Mark Little2,3

  • 1 Intensive Care Unit, Sir Charles Gairdner Hospital, Perth, WA.
  • 2 Emergency Department, Royal Perth Hospital, Perth, WA.
  • 3 Western Australian Poisons Information Centre, Sir Charles Gairdner Hospital, Perth, WA.


Competing interests:

None identified.

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