UMEM Educational Pearls

Category: Toxicology

Title: High dose insulin in cardiogenic shock

Keywords: Insulin,beta blockers,calcium channel blockers (PubMed Search)

Posted: 12/1/2011 by Ellen Lemkin, MD, PharmD
Click here to contact Ellen Lemkin, MD, PharmD

High dose insulin is recommended in treatment of beta-blocker and calcium channel blocker overdose. In a recent observational case series of cardiogenic shock, high dose insulin was evaluated for efficacy and safety.

The overdoses were primarily calcium channel and beta blockers, but included other agents
like tricyclic antidepressants.
  • Insulin doses were given at a maximum of 10 units/kg/hour.
  • Seven patients who were on vasopressors when enrolled were tapered off when placed on high dose insulin.
  • 11/12 patients lived and were discharged from the hospital.
  • Adverse effects included hypoglycemia (19 events) and hypokalemia (8).
Bottom line: High dose insulin, when used in doses up to 10 units/kg/hr allows avoidance of vasopressors, and appears to be effective in the treatment of toxin induced shock in this small case series.


Holger JS, Stellpfug SJ, Cole JB, Harris CR, Engebretsen KM. High-Dose Insulin: A Consecutive Case Series in Toxin-Induced Cardiogenic Shock. Clinical Toxicology Aug 2011;49(7):653-8.