Calcium IV (see xxxx)

• xxx

Hyperinsulinemia-Euglycemia Therapy (see Insulin)

Rationale

• Hyperinsulinemia-Euglycemia Therapy Results in Positive Inotropic Effects in the Treatment of Calcium Channel Blocker Intoxication (J Pharmacol Exp Ther, 1993) [MEDLINE] (NEJM, 2001) [MEDLINE] (Intensive Care Med, 2007) [MEDLINE] (Am J Crit Care, 2007) [MEDLINE]

Administration

• Correct Hypoglycemia and Hypokalemis Prior to Starting Hyperinsulinemia-Euglycemia Therapy
• Titrate Up to Max of 10 U/kg/hr
  • Then Titrate D50W Drip to Maintain Glucose >200 mg/dL

Adverse Effects

• Hypotension (see Hypotension)
  • Especially in the Setting of Amlodipine Overdose
    • Dihydropyridine (Amlodipine, Nifedipine) Intoxication Generally Causes Arterial Vasodilation and Reflex Tachycardia
    • Diltiazem/Verapamil Intoxication Generally Cause Peripheral Vasodilation, Negative Cardiac Inotropy, and Bradycardia
    • However, as the Dose is Increased, This Selectivity of These Agents is Lost, Resulting in Negative Cardiac Inotropy and Bradycardia in the Setting of Dihydropyridine Overdose

Clinical Efficacy

• xxxx