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.
