Cargando…

Insulin versus Lipid Emulsion in a Rabbit Model of Severe Propranolol Toxicity: A Pilot Study

Background and objective. Beta-blocker overdose may result in intractable cardiovascular collapse despite conventional antidotal treatments. High dose insulin/glucose (ING), and more recently intravenous lipid emulsion (ILE), have been proposed as potentially beneficial therapies in beta blocker int...

Descripción completa

Detalles Bibliográficos
Autores principales: Harvey, Martyn, Cave, Grant, Lahner, Daniel, Desmet, Jan, Prince, Gaynor, Hopgood, Gary
Formato: Texto
Lenguaje:English
Publicado: Hindawi Publishing Corporation 2011
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3085310/
https://www.ncbi.nlm.nih.gov/pubmed/21541209
http://dx.doi.org/10.1155/2011/361737
_version_ 1782202618548846592
author Harvey, Martyn
Cave, Grant
Lahner, Daniel
Desmet, Jan
Prince, Gaynor
Hopgood, Gary
author_facet Harvey, Martyn
Cave, Grant
Lahner, Daniel
Desmet, Jan
Prince, Gaynor
Hopgood, Gary
author_sort Harvey, Martyn
collection PubMed
description Background and objective. Beta-blocker overdose may result in intractable cardiovascular collapse despite conventional antidotal treatments. High dose insulin/glucose (ING), and more recently intravenous lipid emulsion (ILE), have been proposed as potentially beneficial therapies in beta blocker intoxication. We compare efficacy of the novel antidotes ING, with ILE, in a rabbit model of combined enteric/intravenous propranolol toxicity. Methods. Sedated, mechanically ventilated and invasively monitored New Zealand White rabbits underwent mini-laparotomy and enterostomy formation with 40 mg/kg propranolol instilled into the proximal small bowel. At 30 minutes propranolol infusion was commenced at 4 mg/kg/hr and continued to a target mean arterial pressure (MAP) of 50% baseline MAP. Animals were resuscitated with insulin at 3 U/kg plus 0.5 g/kg glucose (ING group), or 10 mL/kg 20% Intralipid (ILE group). Results. Rate pressure product (RPP; RPP = heart rate × mean arterial pressure) was greatest in the ING group at 60 minutes (P < .05). A trend toward greater heart rate was observed in the ING group (P = .06). No difference was observed in survival between groups (4/5 ING versus 2/5 ILE; P = .524). Conclusions. High dose insulin resulted in greater rate pressure product compared with lipid emulsion in this rabbit model of severe enteric/intravenous propranolol toxicity.
format Text
id pubmed-3085310
institution National Center for Biotechnology Information
language English
publishDate 2011
publisher Hindawi Publishing Corporation
record_format MEDLINE/PubMed
spelling pubmed-30853102011-05-03 Insulin versus Lipid Emulsion in a Rabbit Model of Severe Propranolol Toxicity: A Pilot Study Harvey, Martyn Cave, Grant Lahner, Daniel Desmet, Jan Prince, Gaynor Hopgood, Gary Crit Care Res Pract Research Article Background and objective. Beta-blocker overdose may result in intractable cardiovascular collapse despite conventional antidotal treatments. High dose insulin/glucose (ING), and more recently intravenous lipid emulsion (ILE), have been proposed as potentially beneficial therapies in beta blocker intoxication. We compare efficacy of the novel antidotes ING, with ILE, in a rabbit model of combined enteric/intravenous propranolol toxicity. Methods. Sedated, mechanically ventilated and invasively monitored New Zealand White rabbits underwent mini-laparotomy and enterostomy formation with 40 mg/kg propranolol instilled into the proximal small bowel. At 30 minutes propranolol infusion was commenced at 4 mg/kg/hr and continued to a target mean arterial pressure (MAP) of 50% baseline MAP. Animals were resuscitated with insulin at 3 U/kg plus 0.5 g/kg glucose (ING group), or 10 mL/kg 20% Intralipid (ILE group). Results. Rate pressure product (RPP; RPP = heart rate × mean arterial pressure) was greatest in the ING group at 60 minutes (P < .05). A trend toward greater heart rate was observed in the ING group (P = .06). No difference was observed in survival between groups (4/5 ING versus 2/5 ILE; P = .524). Conclusions. High dose insulin resulted in greater rate pressure product compared with lipid emulsion in this rabbit model of severe enteric/intravenous propranolol toxicity. Hindawi Publishing Corporation 2011 2011-03-31 /pmc/articles/PMC3085310/ /pubmed/21541209 http://dx.doi.org/10.1155/2011/361737 Text en Copyright © 2011 Martyn Harvey et al. https://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Harvey, Martyn
Cave, Grant
Lahner, Daniel
Desmet, Jan
Prince, Gaynor
Hopgood, Gary
Insulin versus Lipid Emulsion in a Rabbit Model of Severe Propranolol Toxicity: A Pilot Study
title Insulin versus Lipid Emulsion in a Rabbit Model of Severe Propranolol Toxicity: A Pilot Study
title_full Insulin versus Lipid Emulsion in a Rabbit Model of Severe Propranolol Toxicity: A Pilot Study
title_fullStr Insulin versus Lipid Emulsion in a Rabbit Model of Severe Propranolol Toxicity: A Pilot Study
title_full_unstemmed Insulin versus Lipid Emulsion in a Rabbit Model of Severe Propranolol Toxicity: A Pilot Study
title_short Insulin versus Lipid Emulsion in a Rabbit Model of Severe Propranolol Toxicity: A Pilot Study
title_sort insulin versus lipid emulsion in a rabbit model of severe propranolol toxicity: a pilot study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3085310/
https://www.ncbi.nlm.nih.gov/pubmed/21541209
http://dx.doi.org/10.1155/2011/361737
work_keys_str_mv AT harveymartyn insulinversuslipidemulsioninarabbitmodelofseverepropranololtoxicityapilotstudy
AT cavegrant insulinversuslipidemulsioninarabbitmodelofseverepropranololtoxicityapilotstudy
AT lahnerdaniel insulinversuslipidemulsioninarabbitmodelofseverepropranololtoxicityapilotstudy
AT desmetjan insulinversuslipidemulsioninarabbitmodelofseverepropranololtoxicityapilotstudy
AT princegaynor insulinversuslipidemulsioninarabbitmodelofseverepropranololtoxicityapilotstudy
AT hopgoodgary insulinversuslipidemulsioninarabbitmodelofseverepropranololtoxicityapilotstudy