{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T11:24:58Z","timestamp":1783337098109,"version":"3.54.6"},"reference-count":33,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2013,5,8]],"date-time":"2013-05-08T00:00:00Z","timestamp":1367971200000},"content-version":"vor","delay-in-days":7,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Vet Emergen Crit Care"],"published-print":{"date-parts":[[2013,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To describe the novel use of high\u2010dose insulin (<jats:styled-content style=\"fixed-case\">HDI<\/jats:styled-content>) therapy and intravenous lipid emulsion (<jats:styled-content style=\"fixed-case\">ILE<\/jats:styled-content>) to treat refractory, severe diltiazem toxicosis in a dog.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case Summary<\/jats:title><jats:p>A 4\u2010year\u2010old<jats:styled-content style=\"fixed-case\">P<\/jats:styled-content>omeranian was presented for treatment 2.5\u00a0hours following ingestion of a diltiazem extended\u2010release capsule. Toxic ingestion was calculated at a maximum exposure of 79\u00a0mg\/kg, with a reported canine<jats:styled-content style=\"fixed-case\">LD<\/jats:styled-content><jats:sub>50<\/jats:sub>of 50\u00a0mg\/kg. Clinical signs of progressive hypotension and severe bradycardia with atrial standstill were observed, which persisted despite treatment with atropine, calcium, glucagon, and dopamine. The novel use of<jats:styled-content style=\"fixed-case\">HDI<\/jats:styled-content>and<jats:styled-content style=\"fixed-case\">ILE<\/jats:styled-content>as part of therapy for diltiazem toxicosis resulted in clinical resolution of life\u2010threatening signs. Within 1\u00a0hour of initiating<jats:styled-content style=\"fixed-case\">HDI<\/jats:styled-content>therapy, the clinical signs improved, and with continued treatment, the patient remained normotensive and survived to discharge.<\/jats:p><\/jats:sec><jats:sec><jats:title>New or Unique Information Provided<\/jats:title><jats:p>To the authors\u2019 knowledge, this is the first reported clinical case describing the use of both<jats:styled-content style=\"fixed-case\">HDI<\/jats:styled-content>and<jats:styled-content style=\"fixed-case\">ILE<\/jats:styled-content>therapy in the treatment of severe refractory diltiazem toxicosis in veterinary medicine. No significant adverse effects were observed from the treatment. In veterinary patients with severe refractory calcium channel blocker toxicosis, the use of<jats:styled-content style=\"fixed-case\">HDI<\/jats:styled-content>and<jats:styled-content style=\"fixed-case\">ILE<\/jats:styled-content>should be considered for life\u2010threatening clinical signs.<\/jats:p><\/jats:sec>","DOI":"10.1111\/vec.12053","type":"journal-article","created":{"date-parts":[[2013,5,8]],"date-time":"2013-05-08T17:45:43Z","timestamp":1368035143000},"page":"321-327","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["The use of high\u2010dose insulin therapy and intravenous lipid emulsion to treat severe, refractory diltiazem toxicosis in a dog"],"prefix":"10.1111","volume":"23","author":[{"given":"Barbara L.","family":"Maton","sequence":"first","affiliation":[{"name":"AVETS 4224 Northern Pike Monroeville PA 15146"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin 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