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High dose insulin therapy
From WikEM
Background
- Used in beta blocker and calcium channel blocker toxicity
- Response is delayed for 30 to 60 minutes
- Recommend simultaneous implementation of other therapies to support the patient's pulse and blood pressure
Dosing
- Hypoglycemia and hypokalemia must be corrected prior to initiating HDI
- If glucose <150mg/dl, give 50mL of D50W
- Peds: 0.25g/kg, usually given as 2.5mL/kg of D10
- If potassium 3mEq/L, give 20meq of potassium IV
- High-dose insulin therapy
- Bolus of 1 unit/kg of regular, short-acting insulin IV
- then 0.5 units/kg per hour IV, uptitrate until hypotension is corrected (max 10 units/kg per hour)
- Maintain euglycemia by infusion of D5 or D10
- Initial rate 0.5 to 1g of dextrose/kg/hr
- Check POC glucose q15-30 minutes until stable glucose concentration, then check q1hour
- Check serum potassium q 30 minutes until stable, then q 1-2 hours, replete as necessary
- Repletion of magnesium may also be needed
Mechanism of Action
- Mechanism not fully understood
- Thought to optimize use of carbohydrates for fuel by cardiac myocytes and modulate intracellular calcium
- Improves cardiac output by increasing stroke volume
