High dose insulin therapy

Background
  • Used in β-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

See Also

References
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