Details About Overdose or Poisoning Generic Salt ::  Insulin

Insulin

    

Drug Pharmacology ::

I. Pharmacology./b>

   

Insulin, a hormone secreted by the beta cells of the pancreas, promotescellular uptake of glucose into skeletal and cardiac muscles andadipose tissue. Insulin shifts potassium intracellularly.

The mechanism by which insulin-dextrose (hyperinsulinemia-euglycemia)therapy improves inotropy and increases peripheral vascular resistanceis not known. Calcium antagonists inhibit insulin secretion by blockingthe L-type calcium channels of pancreatic islet cells and induceinsulin resistance. Insulin may reverse the hyperglycemia,hypoinsulinemia, and acidosis commonly observed in calcium antagonistpoisoning. In calcium antagonist and beta-adrenergic blocker overdose,myocardial metabolism shifts from free fatty acid to carbohydratemetabolism. Insulin stimulates myocardial metabolism and inhibits freefatty acid metabolism. Insulin may also improve glucose uptake bycardiac myocytes.

Human regular insulin is biosynthetically prepared using recombinantDNA technology. The onset of action to decrease blood glucose forregular insulin is 30 minutes to 1 hour, and the duration of action is5–8 hours. The serum half-life of regular insulin is 4–5 minutes afterIV administration.

Drug Indications ::

Indications

   

Hyperglycemia and diabetic ketoacidosis.

Severe hyperkalemia (Hyperkalemia and hypokalemia).

Administered with dextrose for hypotension induced by calciumantagonists (Calcium Antagonists) and beta-adrenergic blockers(Beta-Adrenergic Blockers). Improved hemodynamics has been reported ina small number of patients with calcium antagonist toxicity.Insulin-dextrose treatment can improve cardiovascular function afterbeta-adrenergic overdose in animals, but its use has not been reportedin humans with beta-adrenergic toxicity.

Drug Contra-Indications ::

III. Contraindications. Known hypersensitivity to the drug (less frequent with human insulin than with animal-derived insulin).

Drug Adverse Effects ::

IV. Adverse effects

   

Hypoglycemia.

Hypokalemia.

Lipohypertrophy or lipoatrophy at injection site (more common with repeated use).

Use in pregnancy. FDA category B (see Table III–1). Human insulin does not cross the placental barrier.

Drug Lab Interactions ::

Drug or laboratory interactions.

   

Hypoglycemia may be potentiated by ethanol, sulfonylureas, and salicylates.

Corticosteroids(by decreasing peripheral insulin resistance and promotinggluconeogenesis), glucagon (by enhanced glycogenolysis), andepinephrine (via beta-adrenergic effects) may antagonize the effects ofinsulin.

Drug Dose Management ::

Dosage and method of administration

   

Hyperglycemia.Administer regular insulin 5–10 U IV initially, followed by infusion of5–10 U/h, while monitoring the effect on serum glucose levels(children: 0.1 U/kg initially and 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):

   

1. Bolusof regular human insulin 1 U/kg IV. If blood glucose < 200 mg/dL,give 50 mL (25 g) of 50% dextrose IV (children: 0.25 g/kg of 25%dextrose).

2. Continuous infusion. Dilute500 U of regular human insulin in 500 mL 0.9% saline (1 U/mL insulinconcentration). Follow bolus with 0.5–1 U/kg/h insulin infusiontitrated to blood pressure 100 mm Hg systolic. Begin 10% dextrose infusion and administer dextroseboluses as needed to maintain glucose between 100–200 mg/dL.

3. Monitoring. Measureblood glucose at least every 15–30 minutes for the first 4 hours untilblood glucose is maintained at 100–200 mg/dL for 4 hours, then everyhour. Monitor blood glucose hourly for several hours after the insulininfusion is discontinued since reactive hypoglycemia may occur. Monitorpotassium hourly initially and then at least every 4 to 6 hours.Replete potassium as needed to maintain potassium > 2.5 mEq/dL.Magnesium and phosphorus levels may also fluctuate.

4. Onset of Effect.Hemodynamic improvement may not occur for more than 30 minutes.Increase insulin infusion after 30–60 minutes if no improvement inblood pressure occurs.

5. Duration of Therapy.Duration of insulin-dextrose treatment has varied from a single insulinbolus to infusions lasting 6 hours to 4 days. Average insulin infusionduration is 24–31 hours.

6. Note:Optimal insulin dosage is not known. An inadvertent bolus of 10 U/kgwas administered without adverse effects. Infusions have ranged from0.1 U/kg/h to 2 U/kg/h.

Drug Chemical Formulations ::

Formulations

   

Parenteral. Humanregular insulin (Humulin R, Novulin R), 100 U/mL, 10-mL vials. Onlyhuman regular insulin can be administered intravenously.

The suggested minimum stocking level to treat a 70-kg adult for the first 24 hours is two 10-mL vials.

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