Maryam Razavi

maryam.razavi@cambio.se

@CambioCDS

Use to calculate insulin dosage and dextrose infusion.

Use in patients with cardiac drug-induced myocardial depression (cardiogenic shock). Glucose, potassium, and ejection fraction should be monitored. Insulin bolus: Intravenous bolus of regular insulin at a dose of 1 unit/kg. If serum glucose <250 mg/dL, concurrently administer a bolus of dextrose 25-50 g (or 0.5-1 g/kg) IV. Note: the calculator assumes D50 (50% dextrose in water) will be given for the initial bolus, and uses the weight-based dosing (0.5-1 g dextrose per kg patient weight; i.e., 1-2 cc D50 per kg patient weight). HIET continuous infusion: Regular insulin: start 0.5–1 unit/kg/hr. Dextrose: 0.5 g/kg/hr (titrate to maintain glucose 110–250 mg/dL). If fluid overload is a concern, the insulin can be concentrated to 10 units/mL. If hypoglycemia does occur, bolus with dextrose and/or increase dextrose infusion first before considering a decrease or cessation of insulin infusion. Continuous monitoring: Serum glucose every 30 minutes for 1-2 hours until stable. Potassium every 1 hour.

Use only to assist with calculation, not intended to provide comprehensive or definitive drug information.

1. Kerns, W. Antidotes in Depth (A18): Insulin-Euglycemia Therapy. Goldfrank’s Toxicologic Emergencies 2015, 10th e. L. S. Nelson, N. A. Lewin, M. Howland et al. New York, NY, McGraw-Hill. 2. Holger JS, Stellpflug SJ, Cole JB, Harris CR, Engebretsen KM. High-dose insulin: a consecutive case series in toxin-induced cardiogenic shock. Clin Toxicol (Phila). 2011;49(7):653-8. 3. Greene SL, Gawarammana I, Wood DM, Jones AL, Dargan PI. Relative safety of hyperinsulinaemia/euglycaemia therapy in the management of calcium channel blocker overdose: a prospective observational study. Intensive Care Med. 2007;33(11):2019-24. 4. Lugassy DM et al. The Critically Ill Poisoned Patient. Emergency Department Resuscitation of the Critically Ill 2015. M. E. Winters, American College of Emergency Physicians.

OBSERVATION.body_weight.v2, OBSERVATION.lab_test_glucose.v1, OBSERVATION.hiet_high_dose_insulin_euglycemia_therapy.v0