1Junior Resident and Post Graduate, Department of Emergency Medicine, J.N Medical College, Belagavi, KLE Academy of Higher Education and Research, Deemed to be University, Belagavi, Karnataka, India 590010
Email: haneenahaneef1234@gmail.com
2Professor & Head of Department, Department of Emergency Medicine, J.N Medical College, Belagavi, KLE Academy of Higher Education and Research, Deemed to be University, Belagavi, Karnataka, India 590010
Email: drsvudapudi@gmail.com
3Assistant Professor, Department of Emergency Medicine, J.N Medical College, Belagavi, KLE Academy of Higher Education and Research, Deemed to be University, Belagavi, Karnataka, India 590010
4Junior Resident & Post Graduate, Department of Emergency Medicine, SRM Institute of Science and Technology, Deemed University, Kattankulathur, Chennai, Tamil Nadu 603203
5Senior Resident, Department of Emergency Medicine, J.N Medical College, Belagavi, KLE Academy of Higher Education and Research, Deemed to be University, Belagavi, Karnataka, India 590010
6Junior Resident & Post Graduate, Department of Emergency Medicine, J.N Medical College, Belagavi, KLE Academy of Higher Education and Research, Deemed to be University, Belagavi, Karnataka, India 590010
7Junior Resident & Post Graduate, Department of Emergency Medicine, J.N Medical College, Belagavi, KLE Academy of Higher Education and Research, Deemed to be University, Belagavi, Karnataka, India 590010
8Junior Resident and Post Graduate, Department of Emergency Medicine, J.N Medical College, Belagavi, KLE Academy of Higher Education and Research, Deemed to be University, Belagavi, Karnataka, India 590010
9Junior Resident and Post Graduate, Department of Emergency Medicine, J.N Medical College, Belagavi, KLE Academy of Higher Education and Research, Deemed to be University, Belagavi, Karnataka, India 590010
10Junior Resident and Post Graduate, Department of Emergency Medicine, J.N Medical College, Belagavi, KLE Academy of Higher Education and Research, Deemed to be University, Belagavi, Karnataka, India 590010
Background: Shock refractory to standard resuscitative measures represents a medical emergency and should prompt evaluation for uncommon etiologies, including toxicological causes. Calcium channel blocker (CCB) overdose is associated with high morbidity and mortality due to severe myocardial depression, vasodilation, metabolic derangements, and multiorgan dysfunction. Early recognition and targeted therapy are crucial for survival.
Case Presentation: A 26-year-old female who presented with nausea, vomiting, and giddiness following intentional ingestion of large quantities of sustained-release diltiazem and amlodipine. On admission, she was profoundly hypotensive with metabolic acidosis, hyperglycemia, and new-onset atrial fibrillation. Despite aggressive initial management with intravenous fluids, calcium supplementation, glucagon, and maximal vasopressor support, the patient remained in refractory shock. Her clinical course was complicated by oliguria, respiratory compromise, pleural effusions, and worsening metabolic abnormalities. Two cycles of hemoperfusion were performed as adjunctive therapy. In view of persistent hemodynamic instability, high-dose insulin euglycaemic therapy (HIET) was initiated and titrated to high infusion rates with concurrent dextrose supplementation. Following initiation of HIET, the patient demonstrated sustained hemodynamic improvement, resolution of metabolic acidosis, and recovery of end-organ function. Vasopressors were successfully tapered, respiratory support was discontinued, and the patient was discharged with complete functional recovery. This case highlights the importance of considering CCB overdose in patients presenting with refractory shock and emphasizes the pivotal role of high-dose insulin euglycaemic therapy as an effective, life-saving treatment in severe CCB toxicity.
Keywords: Calcium channel blocker overdose, Refractory shock, High-dose insulin euglycaemic therapy, Amlodipine toxicity, Diltiazem toxicity, Toxicological shock, Cardiogenic shock, Metabolic acidosis, Hemoperfusion.
How to cite this article: Haneef H, Udapudi SV, Pawar A, Ahmed AA, Hatti MA, Anas TC, Lakshmi M, Unais M, Jishnu KS, Joji S. High-dose insulin euglycaemic therapy in severe calcium channel blocker overdose presenting as refractory shock: A case report. Int J Drug Deliv Technol. 2026;16(6s): 525-530; DOI: 10.25258/ijddt.16.6s.57
Source of support: None.
Conflict of interest: None