High dose insulin therapy

Background

• Used in beta 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

• Beta blocker toxicity
• Calcium channel blocker toxicity
• Lipid emulsion

References

Authors

Lisa Yee