Lipid Rescue Therapy and High-Dose insulin Euglycemic Therapy are Effective for Severe Refractory Calcium Channel Blocker Overdose: Case Report and Review of Literature

Abstract

<em>Background:</em> High-Dose Insulin Euglycemic Therapy (HIET) and Lipid Rescue Therapy (LRT) are new alternative treatments for acute poisoning with calcium channel blockers. In this report a severely poisoned patient with verapamil and furosemide who was successfully treated with these two treatments is presented. <br/><em>Case report:</em> A 27-year-old woman was brought to “Mother Theresa" Clinical Center in Skopje with a history of consumption of 24 grams (100 pills) sustained-release verapamil and 4 grams (10 pills) furosemide. She was alert and oriented with 60/35 mmHg blood pressure (BP), her respiratory rate was 25 breaths/min and heart rate was 40 beats/min with first degree atrioventricular (AV) block on electrocardiogram (ECG). In the first 90 minutes, she received activated charcoal, 1 liter of 0.9% saline, 60 mL of calcium chloride (CaCl₂), 40 mg potassium and subsequently dopamine and 100 mg noradrenaline. However, there was no significant improvement in her hemodynamic status (BP = 70/50 mmHg) and she developed second degree AV block. Temporary pace maker was implanted. In the next one hour, the patient had stable vital signs, when she again became hypotensive (BP = 60/35 mmHg) with prolonged QRS complex (20 msec). During this period she was treated with epinephrine (9mg), atropine (2mg), isoprenalin, bicarbonate, CaCl₂ and intravenous fluid. Unsuccessful conventional treatments indicated administration of HIET and LRT. Three hours later, the BP was normalized (110/75mm) and 36 hours later, all ECG disturbances disappeared. She left the Clinic without any sequels, four days later. <br/><em>Conclusion:</em> LRT in addition to HIET are effective treatments for CCB overdose. LRT can be considered as a standard treatment for CCB overdose. Nevertheless, further investigations are necessary to establish the real value of these treatments. <br/> <br/>How to cite this article: Bekjarovski NG. Lipid Rescue Therapy and High-Dose insulin Euglycemic Therapy are Effective for Severe Refractory Calcium Channel Blocker Overdose: Case Report and Review of Literature. Asia Pac J Med Toxicol 2013;2:114-6.