Management of hypotension in dihydropyridine calcium channel blocker overdose: The role of high-dose insulin therapy.

Amlodipine poisoning is a serious condition that can lead to cardiovascular medication-related deaths. High-dose insulin (HDI) therapy is often used to manage this condition, but its effectiveness in patients with hypotension following dihydropyridine calcium channel antagonist (CCA) overdose is not well understood. A recent retrospective study aimed to investigate the use of HDI therapy in adult patients with deliberate dihydropyridine CCA overdose and hypotension. The study included 50 patients, with 31 (62%) being female and a median age of 57 years. The majority of patients (82%) had co-ingested a renin-angiotensin system antagonist, which can exacerbate the effects of CCA overdose. The study found that 10 patients (20%) received HDI therapy, with a median bolus dose of 1 U/kg and infusion of 1.25 U/kg/h. In contrast, 40 patients (80%) did not receive HDI therapy. The results showed that patients who received HDI had significantly lower median minimal systolic blood pressure and mean arterial pressure prior to starting HDI. Additionally, the HDI group required higher doses of vasopressors and inotropes, with a median dose of noradrenaline used being 1.15 μg/kg/min compared to 0.27 μg/kg/min in the non-HDI group. The study also found that HDI was primarily administered to patients with left ventricular dysfunction, as evidenced by echocardiogram results. Overall, the study suggests that HDI therapy is not commonly used in the management of dihydropyridine CCA poisoning with hypotension, and its use is largely reserved for patients with specific cardiac dysfunction. The findings of this study can help inform the development of treatment guidelines for this condition and improve patient outcomes. Link: https://pubmed.ncbi.nlm.nih.gov/40289269/