{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T07:28:50Z","timestamp":1793345330390,"version":"4.5.0"},"reference-count":14,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2021,11,19]],"date-time":"2021-11-19T00:00:00Z","timestamp":1637280000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,3,21]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Purpose<\/jats:title>\n                  <jats:p>High-dose insulin\/euglycemia (HDIE) is targeted therapy for \u03b2-blocker and calcium channel blocker overdose. A guideline using concentrated insulin infusions (20 units\/mL), aggressive monitoring, and supportive recommendations was implemented. We sought to evaluate safety before and after HDIE guideline implementation and describe the patient population, insulin doses, supplemental dextrose, vasopressor use, hospital and intensive care unit (ICU) lengths of stay, and mortality.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Retrospective review was performed of patients receiving HDIE before and after guideline implementation at an academic medical center and community hospital from March 2011 through December 2019. Information on patient and overdose demographics, ingestion data, vital signs, interventions, adverse events, and disposition was collected. Data are presented descriptively with comparisons using Mann-Whitney U analysis and Fisher\u2019s exact tests.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>During the study period, 27 patients were treated with HDIE, 10 before guideline implementation (37%; mean [SD] initial insulin dose, 0.49 [0.35] units\/kg\/h; mean [SD] maximum insulin dose, 2.25 [3.29] units\/kg\/h; median [interquartile range] duration, 10 [5.5-18.75] hours) and 17 after guideline implementation (63%; mean [SD] initial insulin dose, 1.01 [0.34] units\/kg\/h; mean [SD] maximum insulin dose, 2.99 [5.05] unit\/kg\/h; median [interquartile range] duration, 16 [11.5-37] hours). Hypoglycemia, hypokalemia, and volume overload occurred in 80% vs 29% (P = 0.018), 40% vs 53% (P = 0.69), and 50% vs 65% (P = 0.69) of patients in the preguideline vs postguideline group, respectively. Most patients received an initial insulin bolus (85%; mean [SD], 70.3 [21.8] units, 0.9 [0.26] units\/kg) and vasopressor infusion (85%). More postguideline patients received a dextrose infusion with a concentration of 20% or higher (93% vs 50%, P = 0.015). There were no differences in cardiac arrest, in-hospital mortality, or hospital or ICU length of stay between the groups.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Hypoglycemia was reduced using an HDIE guideline and concentrated insulin.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ajhp\/zxab439","type":"journal-article","created":{"date-parts":[[2021,12,27]],"date-time":"2021-12-27T03:02:22Z","timestamp":1640574142000},"page":"547-555","source":"Crossref","is-referenced-by-count":14,"title":["Evaluation of high-dose insulin\/euglycemia therapy for suspected \u03b2-blocker or calcium channel blocker overdose following guideline implementation"],"prefix":"10.1093","volume":"79","author":[{"given":"Rachel F","family":"Schult","sequence":"first","affiliation":[{"name":"Department of Pharmacy, University of Rochester Medical Center, Rochester, NY, USA"},{"name":"Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Nacca","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tori L","family":"Grannell","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, University of Rochester Medical Center, Rochester, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel M","family":"Jorgensen","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, University of Rochester Medical Center, Rochester, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole M","family":"Acquisto","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, University of Rochester Medical Center, Rochester, NY, USA"},{"name":"Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,11,19]]},"reference":[{"issue":"4","key":"2022032109051309700_CIT0001","doi-asserted-by":"crossref","first-page":"1072","DOI":"10.1378\/chest.10-2726","article-title":"Toxicology in the ICU: part 2: specific toxins","volume":"140","author":"Brooks","year":"2011","journal-title":"Chest."},{"issue":"8","key":"2022032109051309700_CIT0002","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1097\/PEC.0b013e3181b0a504","article-title":"Calcium channel blocker toxicity","volume":"25","author":"Arroyo","year":"2009","journal-title":"Pediatr Emerg Care."},{"issue":"4","key":"2022032109051309700_CIT0003","doi-asserted-by":"crossref","first-page":"277","DOI":"10.3109\/15563650.2011.582471","article-title":"High-dose insulin therapy in \u03b2-blocker and calcium 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toxin-induced cardiogenic shock","volume":"49","author":"Holger","year":"2011","journal-title":"Clin Toxicol."},{"issue":"10","key":"2022032109051309700_CIT0010","doi-asserted-by":"crossref","first-page":"1817","DOI":"10.1016\/j.ajem.2018.02.004","article-title":"High dose insulin for \u03b2-blocker and calcium channel-blocker poisoning: 17 years of experience from a single poison center","volume":"36","author":"Cole","year":"2018","journal-title":"Am J Emerg Med."},{"issue":"9","key":"2022032109051309700_CIT0011","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1080\/15563650.2016.1209766","article-title":"Stability of high-dose insulin in normal saline bags for treatment of calcium channel blocker and \u03b2 blocker overdose","volume":"54","author":"Laskey","year":"2016","journal-title":"Clin Toxicol."},{"issue":"11","key":"2022032109051309700_CIT0012","doi-asserted-by":"crossref","first-page":"2019","DOI":"10.1007\/s00134-007-0768-y","article-title":"Relative safety of hyperinsulinaemia\/euglycaemia therapy in the management of calcium channel blocker overdose: a prospective observational study","volume":"33","author":"Greene","year":"2007","journal-title":"Intensive Care Med."},{"issue":"6","key":"2022032109051309700_CIT0013","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1080\/15563650.2017.1391391","article-title":"The safety of high-dose insulin euglycaemia therapy in toxin-induced cardiac toxicity","volume":"56","author":"Page","year":"2018","journal-title":"Clin Toxicol."},{"issue":"11","key":"2022032109051309700_CIT0014","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1080\/15563650.2020.1725034","article-title":"The unknown known: non-cardiogenic pulmonary edema in amlodipine poisoning, a cohort study","volume":"58","author":"Lindeman","year":"2020","journal-title":"Clin Toxicol."}],"container-title":["American Journal of Health-System 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