Hyperinsulinemia euglycemia therapy is a potentially life-saving treatment for calcium channel blocker toxicity. His bradycardia and hypotension resolved without cardiac pacing or vasopressors.
Eight hours after admission, hyperinsulinemia euglycemia therapy was initiated 3 hours later, the patient's hemodynamic status showed sustained improvement. During the current admission, the patient's clinical condition failed to improve after treatment with charcoal, fluid resuscitation, calcium, and glucagon. During the previous admissions, conventional treatments were used, and complications included hemodynamic compromise, ischemic bowel requiring ileostomy, and a prolonged hospital stay. He had been admitted to the hospital twice before for attempted suicide with diltiazem and nifedipine, respectively. The patient was a 60-year-old man with schizoaffective disorder who presented with severe hemodynamic compromise after an intentional overdose of 5,400 mg of extended-release diltiazem. We report the case of a patient with calcium channel blocker toxicity who was treated successfully with hyperinsulinemia euglycemia therapy, without prior use of vasopressors. Considerable variations in the metabolic capacity of individuals were observed for both organs. Although the sample size in group was relatively low, both NAPQI formation and activity of CYP2E1 were significantly higher in males compared to females in kidney. The small amount of tissue microsomes was sufficient to measure both the formation of NAPQI and the activities of CYP enzymes. Individual microsomes were prepared and incubated with PAR (for quantifying bioactivation), with nifedipine (for measuring CYP3A4 activity) and with p-nitrophenol (for measuring CYP2E1 activity). In order to develop liquid chromatography mass spectrometry (LC-MS)-based methods to process small amounts of human tissues, liver and kidney samples were obtained. Available HPLC-based methods require high amounts of tissue samples. It is essential to measure organ-specific activities of related CYPs for evaluating the overdose cases. Paracetamol (PAR) overdose is associated with massive hepatic injury it may induce kidney toxicity as well.
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