Related Experiment Video
Updated: Jul 12, 2026
11:10
Hyperinsulinemic-euglycemic Clamps in Conscious, Unrestrained Mice
Published on: November 16, 2011
Hyperinsulinemic euglycemia therapy for verapamil poisoning: case report
Nirav P Patel1, Meredith E Pugh, Steven Goldberg
1Division of Pulmonary, Allergy, and Critical Care Medicine and the Center for Sleep and Respiratory Neurobiology, Hospital of the University of Pennsylvania, 3600 Spruce Street, Philadelphia, PA 19104, USA. nirav.patel@uphs.upenn.edu
Summary
This case study highlights a severe verapamil overdose successfully treated with hyperinsulinemic euglycemia therapy. This advanced treatment resolved critical bradycardia and hemodynamic instability, showcasing its efficacy in managing calcium channel blocker toxicity.
Area of Science:
- Cardiology
- Toxicology
- Emergency Medicine
Background:
- Intentional overdose of sustained-release verapamil presents a significant clinical challenge.
- Co-ingestion of captopril and glyburide can complicate overdose management.
- Verapamil overdose can lead to severe bradycardia and hypotension.
Observation:
- A 49-year-old female presented with profound bradycardia (32/min) and hypotension (BP 72/39 mm Hg) after ingesting sustained-release verapamil.
- Initial management with fluids, vasopressors, activated charcoal, atropine, and calcium chloride failed to improve the patient's condition.
- The patient required intubation and mechanical ventilation due to decreased Glasgow Coma Scale score.
Findings:
- Hyperinsulinemic euglycemia therapy, initiated with regular insulin bolus and infusion alongside 10% dextrose, led to significant clinical improvement.
- Bradycardia resolved, and hemodynamic parameters stabilized within 24 hours of initiating this therapy.
- The patient's cardiac indices normalized, allowing for transfer from the intensive care unit.
Implications:
- Hyperinsulinemic euglycemia therapy is a highly effective treatment for severe verapamil-induced cardiotoxicity.
- This therapeutic approach offers a viable alternative when conventional treatments are insufficient.
- Successful management of verapamil overdose underscores the importance of advanced toxicological interventions.
Related Concept Videos
01:15Hypoglycemia and Glucagon
Without prolonged fasting, healthy individuals maintain blood glucose levels above 3.5 mM due to a well-adapted neuroendocrine counterregulatory system that effectively prevents acute hypoglycemia, a potentially life-threatening condition. The primary clinical scenarios for hypoglycemia encompass diabetes treatment, inappropriate production of endogenous insulin or insulin-like substances by tumors, and the use of glucose-lowering agents in non-diabetic individuals. Notably, hypoglycemia in the...
01:26Pharmaceutical Poisoning: Treatment Strategies
Treatment strategies for poisoning are a critical aspect of emergency medicine, focusing on preventing the absorption of toxins and enhancing their elimination. When a poisoning incident occurs, the first response is to halt exposure and decontaminate the patient, particularly through gastrointestinal (GI) methods if the poison was ingested.Gastrointestinal Decontamination Techniques:Activated charcoal is the cornerstone of GI decontamination. It works through adsorption, binding the toxin to...
01:16Insulin: Dosing Regimen and Adverse Effects
Insulin-replacement therapy usually includes both long-acting insulin (basal) and short-acting insulin (to cater to postprandial needs). In a diverse group of type 1 diabetes patients, the average daily insulin dose is typically 0.5-0.7 units/kg body weight. However, obese patients and pubertal adolescents may need more due to insulin resistance.
The basal dose constitutes about 40%-50% of the total daily dose, with the rest as premeal insulin. The mealtime insulin dose should mirror...
The basal dose constitutes about 40%-50% of the total daily dose, with the rest as premeal insulin. The mealtime insulin dose should mirror...
01:26Anticholinesterase Agents: Poisoning and Treatment
Anticholinesterases, also known as cholinesterase inhibitors, work by blocking the breakdown of acetylcholine, leading to its accumulation in the synaptic cleft. This accumulation indirectly enhances both muscarinic and nicotinic actions. These agents are classified as reversible or irreversible based on their mechanism of action.
Irreversible agents form a strong bond with the cholinesterase enzyme, making it inactive. The breakdown of the phosphorylated enzyme is slower than the...
Irreversible agents form a strong bond with the cholinesterase enzyme, making it inactive. The breakdown of the phosphorylated enzyme is slower than the...
01:29Hyperglycemia
Hyperglycemia is an abnormally high blood glucose level. It is diagnosed by fasting glucose ≥126 mg/dL, 2-hour oral glucose tolerance test (or OGTT) ≥200 mg/dL, random glucose ≥200 mg/dL with symptoms, or HbA1c ≥6.5%. However, HbA1c results may be unreliable in certain conditions, such as anemia or hemoglobinopathies, and the diagnosis should be confirmed unless classic symptoms are present. Postprandial hyperglycemia is typically considered significant when glucose levels exceed 180 mg/dL two...
01:25ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias
Arrhythmia is a condition characterized by an irregular heart rhythm, with ECG changes that differ based on its origin and nature. The types of arrhythmias discussed below include atrial, junctional, and ventricular arrhythmias.Atrial ArrhythmiasPremature Atrial Complexes (PACs): PACs are early atrial beats caused by stress, caffeine, alcohol, electrolyte imbalances, hypoxia, hyperthyroidism, or certain medications (e.g., bronchodilators and decongestants). The ECG shows early P waves with an...