Background: This study highlights the increasing recommendations by poison centers to use HDI for severe CCB/BB overdose with most having developed protocols. Several recent studies and case series have demonstrated that the use of high dose insulin can improve hemodynamics and potentially survival and neurologic recovery after calcium channel blocker (CCB) and beta-adrenergic antagonist (BB) toxicity leading to shock.
Objectives: We wished to ascertain the extent to which poison centers were recommending this treatment, and what opinions are held by poison center directors regarding its use.
Methods: An internet-based survey of the 51 US poison centers was conducted, with poison center directors chosen from published directories of the American Association of Poison Control Centers. Medical directors were questioned regarding recommendations for high dose insulin (HDI) in patients poisoned with CCBs and BBs, protocols employed, and/or reasons why they do not recommend or have not developed protocols for using HDI euglycemia in the care of CCB or BB overdosed patients.
Results: Completed surveys were collected from 40% of poison center directors. Respondents were geographically well distributed. Most respondents (76%) practiced at either larger referral hospitals or academic medical centers. When asked if they had ever recommended HDI for CCB or BB OD, 84% said they had, 5% had not, and 10% recommend HDI occasionally. Forty-five percent recommend HDI as second line and 10% as first line treatment. Among reasons cited for non-recommendation,all felt that there were not enough data. The majority of respondents (82%) initiate treatment with a bolus, followed by infusion. Sixty percent of respondents have a written protocol to use HDI as first or second line treatment in severe CCB or BB overdose.
Conclusion: