Tuesday September 11, 2007
Correlation of serum glucose concentrations with the severity of the calcium channel blocker intoxication

A very unusual study (n=40 patients) published in this month of "Critical Care Medicine", looking into correlation of serum glucose concentrations with the severity of the calcium channel blocker intoxication 1.

Background: Overdoses of calcium channel blocker agents result in hyperglycemia, primarily due to the blockade of pancreatic L-type calcium channels and insulin resistance on the cellular level. The clinical significance of the hyperglycemia in this setting has not previously been described.

Methods: This study was a retrospective review of all adult (age, >=15 yrs) patients with a discharge diagnosis of acute verapamil or diltiazem overdose at five university-affiliated teaching hospitals.

The severity of overdose was assessed by determining whether a patient met the composite end points of

• in-hospital mortality,
• the necessity for a temporary pacemaker, or
• the need for vasopressors

Initial and peak serum glucose concentrations were compared with hemodynamic variables between patients who did and did not meet the composite end points.

Result:

• For those patients who did and did not meet the composite end points, the median initial serum glucose concentrations were 188 (range, 143.5-270.5) mg/dL and 129 (98.5-156.5) mg/dL, respectively (p = .0058).
• The median peak serum glucose concentrations for these two groups were 364 (267.5-408.5) mg/dL and 145 (107.5-160.5) mg/dL, respectively (p = .0001).
• The median increase in blood glucose was 71.2% for those who met composite end points vs. 0% for those who did not meet composite end points (p = .0067).
• Neither the change in the median heart rate nor the change in systolic blood pressure was significantly different in any group.

Conclusion: Serum glucose concentrations correlate directly with the severity of the calcium channel blocker intoxication. The percentage increase of the peak glucose concentration is a better predictor of severity of illness than hemodynamic derangements. If validated prospectively, serum glucose concentration alone might be an indicator to begin hyperinsulinemia-euglycemia therapy.


Related previous pearl:

Calcium Channel blocker overdose

Regarding Calcium Channel blocker overdose - hyperinsulin/euglycemia therapy


Recommended Reading:

Treatment of Calcium-Channel–Blocker Intoxication with Insulin Infusion - The New England Journal of Medicine , May 31, 2001, Volume 344:1721-1722

High-Dose Insulin Therapy for Calcium-Channel Blocker Overdose - Shepherd and Klein-Schwartz Ann Pharmacother.2005; 39: 923-930




Reference: click to get refrence/article

1. Assessment of hyperglycemia after calcium channel blocker overdoses involving diltiazem or verapamil - Critical Care Medicine. 35(9):2071-2075, September 2007.