![]() ![]() Case reports and smaller series of successful HDI use exist, but frequently are reported by medical toxicologists performing bedside consultation and may suffer from positive reporting bias, ,, ,, ]. The largest published series to date is a brief analysis of 46 poison center cases for which HDI was recommended for calcium channel-blocker poisoning. In fact, HDI use in humans is poorly described. ![]() ![]() Though expert consensus guidelines recommend HDI if basic supportive care has failed, there is a relative paucity of human case experience with HDI. 1) recommends titrating HDI from 1 to 10 U/kg/h, based on data suggesting cardiac output increases approximately 50% from an HDI dose of 1 U/kg/h to 10 U/kg/h. In our regional poison center, the clinical guideline for the treatment of beta-blocker and calcium channel-blocker poisoning recommends starting HDI prior to vasopressors after basic supportive care has failed. As such, emergency physicians may be unfamiliar with HDI and the implementation of this complex therapy. Despite basic science evidence that HDI is superior to vasopressors for poisoning from both calcium channel-blockers and beta-blockers, consensus does not yet exist regarding which therapy to start first after basic supportive care, such as IV fluids and calcium salts, has failed. High dose insulin (HDI) has become a standard therapy for poisoning from both beta-blockers and calcium channel-blockers. In 2016, cardiovascular drugs as a class were the second leading cause of poisoning deaths reported to the National Poison Data System (NPDS), the vast majority of which were beta-blockers and calcium channel-blockers. Cardiovascular drugs cause a substantial number of poisoning deaths each year, primarily from acute overdose. ![]()
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