tailieunhanh - Báo cáo y học: "Bench-to-bedside review: Hyperinsulinaemia/euglycaemia therapy in the management of overdose of calcium-channel blockers"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care cung cấp cho các bạn kiến thức về ngành y đề tài: Bench-to-bedside review: Hyperinsulinaemia/euglycaemia therapy in the management of overdose of calcium-channel blockers. | Available online http content 10 3 212 Review Bench-to-bedside review Hyperinsulinaemia euglycaemia therapy in the management of overdose of calcium-channel blockers Philippe ER Lheureux Soheil Zahir Mireille Gris Anne-Sophie Derrey and Andrea Penaloza Acute Poisoning Unit Department of Emergency Medicine Erasme University Hospital 808 route de Lennik B 1070 Brussels Belgium Corresponding author Philippe ER Lheureux plheureu@ Published 22 May 2006 Critical Care 2006 10 212 doi cc4938 This article is online at http content 10 3 212 2006 BioMed Central Ltd Abstract Hyperinsulinaemia euglycaemia therapy HIET consists of the infusion of high-dose regular insulin usually to 1 lU kg per hour combined with glucose to maintain euglycaemia. HIET has been proposed as an adjunctive approach in the management of overdose of calcium-channel blockers CCBs . Indeed experimental data and clinical experience although limited suggest that it could be superior to conventional pharmacological treatments including calcium salts adrenaline epinephrine or glucagon. This paper reviews the pathophysiological principles underlying HIET. Insulin administration seems to allow the switch of the cell metabolism from fatty acids to carbohydrates that is required in stress conditions especially in the myocardium and vascular smooth muscle resulting in an improvement in cardiac contractility and restored peripheral resistances. Studies in experimental verapamil poisoning in dogs have shown that HIET significantly improves metabolism haemodynamics and survival in comparison with conventional therapies. Clinical experience currently consists only of a few isolated cases or short series in which the administration of HIET substantially improved cardiovascular conditions in life-threatening CCB poisonings allowing the progressive discontinuation of vasoactive agents. While we await further well-designed clinical trials some rational recommendations are made