TY  - CHAP
M1  - Book, Section
TI  - INSULIN
A1  - Birnbaum, Kathleen
A2  - Olson, Kent R.
A2  - Anderson, Ilene B.
A2  - Benowitz, Neal L.
A2  - Blanc, Paul D.
A2  - Clark, Richard F.
A2  - Kearney, Thomas E.
A2  - Kim-Katz, Susan Y.
A2  - Wu, Alan H. B.
PY  - 2018
T2  - Poisoning & Drug Overdose, 7e
AB  - Pharmacology1Insulin,  a  hormone  secreted  by  the  beta  cells  of  the  pancreas,  promotes  cellular  uptake  of  glucose  into  skeletal  and  cardiac  muscles  and  adipose  tissue.  Insulin  shifts  potassium  intracellularly.There  are  several  mechanisms  by  which  high-dose  insulin  (hyperinsulinemia-euglycemia  [HIE])  therapy  may  improve  cardiac  output:In  calcium  antagonist  and  beta-adrenergic  blocker  overdose,  myocardial  metabolism  shifts  from  free  fatty  acid  to  carbohydrate  metabolism;  insulin  increases  myocardial  uptake  of  glucose,  lactate,  and  oxygen.High-dose  insulin  increases  calcium-dependent  inotropic  effects.High-dose  insulin  enhances  nitric  oxide  synthase  activity,  which  dilates  coronary,  pulmonary  and  systemic  blood  vessels,  leading  to  improved  cellular  perfusion.Human  regular  insulin  is  biosynthetically  prepared  with  recombinant  DNA  technology.  The  onset  of  action  to  decrease  blood  glucose  for  regular  insulin  is  30  minutes  to  1  hour,  and  the  duration  of  action  is  5–8  hours.  The  onset  of  action  for  high-dose  insulin  is  not  known  but  is  frequently  stated  to  be  15–45  minutes.  The  serum  half-life  of  regular  insulin  at  normal  doses  is  4–5  minutes  after  IV  administration.IndicationsHyperglycemia  and  diabetic  ketoacidosis.Severe  hyperkalemia.Administration  with  dextrose  for  hypotension  induced  by  calcium  antagonists  and  beta-adrenergic  blockers.  Improved  hemodynamics  have  been  reported  in  case  reports  of  patients  with  calcium  antagonist  toxicity  and  beta-adrenergic  blocker  overdose.Contraindications.  Known  hypersensitivity  to  the  drug  (less  frequent  with  human  insulin  than  with  animal-derived  insulin).Adverse  effectsHypoglycemia.Hypokalemia.Lipohypertrophy  or  lipoatrophy  at  injection  site  (more  common  with  repeated  use).Fluid  overload  and  hyponatremia  with  high-dose  insulin  infusion.  Consider  using  concentrated  solutions  of  insulin  and  dextrose,  given  via  a  central  line.Use  in  pregnancy.  FDA  Category  B  (Introduction).  Human  insulin  does  not  cross  the  placental  barrier.Drug  or  laboratory  interactionsHypoglycemia  may  be  potentiated  by  ethanol,  sulfonylureas,  and  salicylates.Corticosteroids  (by  decreasing  peripheral  insulin  resistance  and  promoting  gluconeogenesis),  glucagon  (by  enhanced  glycogenolysis),  and  epinephrine  (via  beta-adrenergic  effects)  may  antagonize  the  effects  of  insulin.Dosage  and  method  of  administrationHyperglycemia.  Administer  regular  insulin  5–10  U  IV  initially,  followed  by  infusion  of  5–10  U/h,  while  monitoring  the  effect  on  serum  glucose  levels  (children:  0.1  U/kg  initially,  then  0.1  U/kg/h).Hyperkalemia.  Administer  regular  insulin  0.1  U/kg  IV  with  50  mL  of  50%  dextrose  (children:  0.1  U/kg  insulin  with  2  mL/kg  of  25%  dextrose).Hypotension  from  calcium  antagonists  and  beta-adrenergic  blockers  unresponsive  to  conventional  therapy  (hyperinsulinemia-euglycemia  therapy):Bolus  of  regular  human  insulin  1  U/kg  IV.  If  blood  glucose  is  below  200  mg/dL,  give  50  mL  (25  g)  of  50%  dextrose  IV  (children:  0.25  g/kg  of  25%  dextrose).Continuous  infusion.  Wide  variations  in  insulin  dose  and  duration  have  been  reported.  Doses  as  high  as  10  U/kg/h  have  been  administered.  The  most  commonly  recommended  infusion  rate  is  1–10  U/kg/h.  Start  at  1  U/kg/h  and  increase  by  1–2  U/kg/h  every  10  minutes  as  needed  to  maintain  satisfactory  perfusion  of  vascular  beds.  Because  of  the  vasodilation  associated  with  HIE  therapy,  do  not  make  dose  adjustments  based  on  the  blood  pressure  alone.Insulin  solutions  are  often  made  by  diluting  500  U  of  regular  human  insulin  in  500  mL  of  0.9%  saline  (insulin  concentration,  1  U/mL).  However,  to  avoid  fluid  overload,  a  concentrated  insulin  infusion  of  10  U/mL  (10,000  U  of  regular  human  insulin  in  1  L  of  0.9%  saline)  or  greater  may  be  used.Maintain  euglycemia  with  boluses  ...
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/18
UR  - accessmedicine.mhmedical.com/content.aspx?aid=1174607458
ER  -