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    Attention COACH STUDY participants:

    The principal investigators of the study request that you use the official version of the modified score here.

    High-dose Insulin Euglycemia Therapy (HIET)

    Doses insulin for calcium-channel blocker or beta blocker overdose.

    IMPORTANT

    This dosing tool is intended to assist with calculation, not to provide comprehensive or definitive drug information. Always double-check dosing of any drug and consult a pharmacist when necessary.

    INSTRUCTIONS

    Use in patients with cardiac drug-induced myocardial depression (cardiogenic shock).

    When to Use
    Pearls/Pitfalls
    Why Use
    • Cardiac induced myocardial depression from CCB toxicity (strongest evidence).
    • May also be used in cardiac induced myocardial depression from beta blocker toxicity.
    • Ultimate goal of HIET is improvement in organ perfusion.
    • Glucose, potassium, and ejection fraction should be monitored.
    • Most common adverse effects of HIET include hypoglycemia and hypokalemia.
    • Hypoglycemia may occur up to several hours after the insulin infusion has been completed.
    • Concentrate insulin infusion to prevent fluid overload.
    • Works by increasing myocardial glucose uptake, resulting in improved contractility.

    HIET should be considered concurrently with, or even prior to, initiation of vasopressors. HIET alone may improve the patient’s hemodynamic status, thus making vasopressors unnecessary and avoiding potential complications of vasopressor use.

    lbs
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    D50
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    Creator Insights
    Dr. Lewis Goldfrank

    About the Creator

    Lewis Goldfrank, MD, FACEP, FAAEM, FAACT, FACMT, FACP, is the Herbert W. Adams Professor of Emergency Medicine at New York University. He is also the medical director of the New York City Poison Control Center. Dr. Goldfrank is perhaps best known as author and editor of the primary toxicology reference Goldfrank's Toxicologic Emergencies.

    To view Dr. Lewis Goldfrank's publications, visit PubMed

    Are you Dr. Lewis Goldfrank? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
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    Dr. Lewis Goldfrank
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