UCSF

Hyperinsulinemia euglycemia (HIE) and intravenous fat emulsion (IFE) may be beneficial in the treatment of calcium channel (CCB) and beta receptor (BB) antagonist toxicity. Many poison control centers (PCC) now recommend use. Healthcare providers may be unfamiliar with these treatments and may not institute them despite recommendations. We sought to determine how often HIE and IFE are recommended by a statewide PCC in CCB and BB toxicity, how often those recommendations are implemented, and whether a faxable information sheet increased adherence. All cases of CCB and BB exposure from January 2005-July 2011 where insulin or "other therapy" was coded were reviewed. Exclusion criteria included an incomplete PCC record, miscoding, and insulin administration as other than cardiovascular drug antidotal therapy. There were 215 CCB or BB exposures initially identified using the search criteria. HIE was recommended in 71 cases and started in one case prior to PCC recommendation. HIE was subsequently used in 30 cases after PCC recommendation (42 %). IFE was recommended by the PCC in 30 cases and implemented 10 times (33 %). In six cases, both HIE and IFE were implemented after recommendation. There was no statistical difference when recommendation was made via telephone or by faxable information sheet for HIE or IFE. HIE and IFE are two therapies that are potentially beneficial in the treatment of BB and CCB toxicity. Current national organization guidelines for use are limited. Exploration of reasons for not following recommendations and additional efforts to improve clinician education regarding HIE and IFE may be required to increase the utilization of these potentially lifesaving antidotes.