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Severe suicidal digoxin and propranolol toxicity with insulin overdose
Ashish Garg1, Soutik Panda1, Pradip Dalvi1
1Department of Critical Care and Emergency Medicine, Sir Ganga Ram Hospital, New Delhi, India.
Summary
A doctor survived a massive overdose of digoxin, propranolol, and insulin. Treatment included hemoperfusion, glucagon, and dextrose infusion, leading to full recovery.
Area of Science:
- Toxicology
- Cardiology
- Endocrinology
Background:
- A 32-year-old male physician with type 1 diabetes mellitus presented with a deliberate overdose of digoxin, propranolol, and insulin.
- The patient was on daily insulin therapy for his diabetes mellitus.
Observation:
- Initial laboratory results showed significantly elevated serum digoxin (7.5 ng/ml) and insulin (500 μIU/ml) levels, with a low C-peptide level (0.43 ng/ml).
- The patient presented with a complex poisoning scenario involving multiple pharmacologic agents.
Findings:
- Management involved charcoal-based hemoperfusion for digoxin toxicity and glucagon administration for propranolol toxicity.
- Continuous 20% dextrose infusion was crucial for maintaining adequate blood glucose levels during treatment.
- The patient demonstrated significant clinical improvement, evidenced by decreasing digoxin levels, normalized pulse rate, and stable blood glucose.
Implications:
- This case highlights the successful management of a life-threatening polypharmacy overdose.
- Effective intervention strategies are critical for patients with combined digoxin, propranolol, and insulin toxicity.
- Psychiatric consultation is essential for patients with suicidal intent and substance abuse.
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