Ver el código de «High dose insulin therapy»

==Background==
*Used in [[beta blocker toxicity| 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==
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[[Category:Pharmacology]]
[[Category:Toxicology]]