Treatment of Calcium-Channel–Blocker Intoxication with Insulin Infusion

Abstract

To the Editor: Overdose of calcium-channel blockers remains an important cause of fatal poisoning.1 Conventional therapy, consisting of intravenous fluids, calcium, dopamine, dobutamine, norepinephrine, and glucagon, often fails to improve hemodynamic function in intoxicated patients.2 Recent recommendations for treatment of intoxication with calcium-channel blockers include induction of hyperinsulinemia and euglycemia as adjunctive therapy.3 We report two cases of overdose of calcium-channel blockers in which a striking benefit was achieved with hyperinsulinemia–euglycemia therapy. A 34-year-old nondiabetic woman with hypertension and renal failure ingested 12 extended-release tablets containing 2.5 mg of amlodipine each. Hypotension and bradycardia developed. Because of her history of . . .