{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T22:04:48Z","timestamp":1778623488307,"version":"3.51.4"},"reference-count":11,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,3,31]],"date-time":"2025-03-31T00:00:00Z","timestamp":1743379200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["Emerging Leadership 1 ID 2016380"],"award-info":[{"award-number":["Emerging Leadership 1 ID 2016380"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Emerg Medicine Australasia"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>High dose insulin therapy has become an increasingly popular treatment for poisonings over the last two decades. It is often mistakenly considered an antidote for poisonings of multiple drug classes, including beta\u2010blocker and calcium channel blocker overdose. This misconception has encouraged overzealous and, at times, inappropriate use, particularly in patients who have vasoplegic shock following poisonings from drugs such as dihydropyridine calcium channel blockers. High dose insulin is not an antidote, but rather an inodilator. Its relatively slow onset of action, compared to catecholamine\u2010based inotropes, of 15\u201360\u2009min makes it best suited to second\u2010line therapy for cardiogenic shock in poisonings. It has no role in isolated vasoplegic shock where it may exacerbate toxicity. It should be used concurrently with noradrenaline to counteract insulin\u2010induced vasodilation. High dose insulin has predictable adverse effects of hypoglycaemia and electrolyte disturbances, particularly hypokalaemia, which can persist long beyond cessation.<\/jats:p>","DOI":"10.1111\/1742-6723.70035","type":"journal-article","created":{"date-parts":[[2025,3,31]],"date-time":"2025-03-31T10:34:36Z","timestamp":1743417276000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["High dose insulin is an inodilator, not an antidote in the poisoned patient!"],"prefix":"10.1111","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1176-7923","authenticated-orcid":false,"given":"Katherine Z","family":"Isoardi","sequence":"first","affiliation":[{"name":"Clinical Toxicology Unit Princess Alexandra Hospital  Brisbane Australia"},{"name":"Queensland Poisons Information Centre Queensland Children's Hospital  Brisbane Australia"},{"name":"Faculty of Medicine University of Queensland  Brisbane Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0083-282X","authenticated-orcid":false,"given":"Betty","family":"Chan","sequence":"additional","affiliation":[{"name":"Clinical Toxicology Unit Prince of Wales Hospital  Sydney Australia"},{"name":"NSW Poisons Information Centre Sydney Children's Hospital  Sydney Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0079-5056","authenticated-orcid":false,"given":"Angela L","family":"Chiew","sequence":"additional","affiliation":[{"name":"Clinical Toxicology Unit Prince of Wales Hospital  Sydney Australia"},{"name":"NSW Poisons Information Centre Sydney Children's Hospital  Sydney Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,3,31]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/bcp.15641"},{"key":"e_1_2_6_3_1","volume-title":"The Toxicology Handbook","author":"Armstrong J","year":"2022"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.3390\/toxics11090723"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.3109\/15563650.2011.582471"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1080\/15563650.2019.1580372"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/bcp.12763"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1080\/15563650.2017.1391391"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.2165\/00139709\u2010200423040\u201000002"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/bcp.16258"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1080\/15563650.2022.2131565"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1080\/15563650.2020.1826504"}],"container-title":["Emergency Medicine Australasia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1742-6723.70035","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,16]],"date-time":"2025-05-16T04:14:29Z","timestamp":1747368869000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/1742-6723.70035"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,31]]},"references-count":11,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2025,4]]}},"alternative-id":["10.1111\/1742-6723.70035"],"URL":"https:\/\/doi.org\/10.1111\/1742-6723.70035","archive":["Portico"],"relation":{},"ISSN":["1742-6731","1742-6723"],"issn-type":[{"value":"1742-6731","type":"print"},{"value":"1742-6723","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,31]]},"assertion":[{"value":"2025-01-16","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-03-11","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-03-31","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70035"}}