UMEM Educational Pearls

 

High dose insulin (HDI) therapy is commonly used in patients with severe beta-adrenergic antagonist and calcium channel antagonist overdose. Hypoglycemia and hypokalemia are commonly known complication of HDI therapy. However, kinetics of insulin in patients who received HDI therapy is unknown.

A 51 year-old man with amlodipine overdose was infused HDI (10 unit/kg/hr) for 37 hours; Serial serum insulin levels were drawn after discontinuation of HDI.

Serum insulin levels are shown in below table

Table    Description automatically generated

The serum insulin level remained significantly elevated during the first 24 hours (normal range: 2.6-24.9 microU/mL) and gradually decreased over 6 days.

Conclusion

  • The supraphysiologic insulin levels persist after discontinuation of HDI where patient may continue to experience hypoglycemia
  • These elevated insulin level may allow for more rapid titration or simply discontinue HDI when hemodynamic stability is achieved.

References

Corcoran JN et al. Persistent hyperinsulinemia following high-dose insulin therapy: a case report. J Med Toxicol 2020;16:465-469.


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