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Updated: May 1, 2026

Improving IV Insulin Administration in a Community Hospital
Published on: June 11, 2012
High dose insulin therapy, an evidence based approach to beta blocker/calcium channel blocker toxicity
Christina Woodward, Ali Pourmand1, Maryann Mazer-Amirshahi
1Department of Emergency Medicine, George Washington University, Washington, DC 20037, USA. Pourmand@gwu.edu.
Abstract:
Poison-induced cardiogenic shock (PICS) as a result of beta-blocker (β-blocker) or calcium channel blocker (CCB) overdose is a common and potentially life-threatening condition. Conventional therapies, including fluid resuscitation, atropine, cardiac pacing, calcium, glucagon, and vasopressors often fail to improve hemodynamic status. High-dose insulin (HDI) is an emerging therapeutic modality for PICS. In this article, we discuss the existing literature and highlight the therapeutic success and potential of HDI. Based on the current literature, which is limited primarily to case series and animal models, the authors conclude that HDI can be effective in restoring hemodynamic stability, and recommend considering its use in patients with PICS that is not responsive to traditional therapies. Future studies should be undertaken to determine the optimal dose and duration of therapy for HDI in PICS.
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