Management of XXXX @entity1445 with hyperinsulinaemic euglycaemia therapy: case report.

@entity410 @entity137 @entity1168 @entity460 @entity3897 @entity50664 @entity551 @entity1445
This case report describes the first reported @entity1445 of the dihydropyridine @entity460 channel blocker (CCB) @entity50664 . A 49 yr old male presented to the Emergency Department 3 hrs after the ingestion of 560 mg of @entity50664 . In the department he had a witnessed @entity410 within 15 minutes of arrival attributed to the @entity1445 . Following immediate recovery of consciousness after the @entity410 , he had refractory @entity551 and @entity1168 which failed to respond to fluid resuscitation, glucagon therapy, and intravenous @entity460 . He went on to require vasopressor support with noradrenaline and was treated with high dose insulin therapy which was successful in achieving cardiovascular stability. Vasopressor therapy was no longer required within one half life of @entity50664 , and the total stay on intensive care was one day before transfer to a ward. @entity460 channel blocker @entity1445 is an uncommon but life-threatening @entity1445 . Treatment for severe @entity137 is similar to b-blocker @entity1445 . @entity551 is treated with intravenous fluid therapy, intravenous @entity460 and possibly glucagon with vasopressor or inotropic support as required. @entity3897 is used to attempt reversal of @entity1168 . High doses of intravenous insulin with intravenous dextrose as required (hyperinsulinaemic euglycaemia or HIET), has also been successfully reported. Experimental animal data suggests that HIET is of benefit and potentially superior to fluid therapy, @entity460 , glucagon and potentially vasopressor therapy. HIET effectively and sustainably reverses @entity551 , @entity1168 and improves myocardial contractility and metabolism. Current advice in @entity460 channel blocker @entity1445 is to begin therapy early in @entity137 , starting with a 1.0 IU/kg insulin bolus followed by an infusion of 0.5 IU/kg/hr of insulin and dextrose as required titrated to clinical response.
