CHEST Guidelines-High-Dose-Insulin-Euglycemic-Therapy-in-the-Treatm

High-Dose-Insulin-Euglycemic-Therapy-in-the-Treatm

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The document is a case report detailing the treatment of a 33-year-old woman who experienced a prolonged cardiac arrest due to a massive caffeine overdose. The patient's condition included tonic-clonic seizures and repeated cardiac arrests. Standard resuscitation methods were initially unsuccessful. Despite valiant efforts and comprehensive treatment following standard protocols, initial resuscitation attempts seemed futile.<br /><br />As a last resort, the medical team initiated High-Dose Insulin Euglycemic Therapy (HIET), which immediately improved her condition. The patient's cardiac output and neurological status showed dramatic improvements, leading to a recovery of full cardiac and neurological function. This case appears to be the first documented successful use of HIET for caffeine overdose treatment. Typically, HIET has been employed in beta-blocker, calcium channel blocker, and tricyclic antidepressant overdoses.<br /><br />HIET involves administering a high dose of insulin alongside glucose and potassium chloride to regulate blood sugar and electrolyte levels while enhancing cardiac output and glucose metabolism. This case suggests that this approach improved microvascular recruitment and myocardial metabolism, which unexpectedly facilitated recovery in a seemingly hopeless situation. The treatment was continued for 72 hours, and despite the large cumulative dose of insulin, hypoglycemia and hypokalemia were effectively prevented.<br /><br />The patient had a serum caffeine concentration three times the lethal limit, yet survived with full neurological recovery, albeit with some amnesia regarding the event. This report has led to considerations for further research into HIET's effectiveness in rare toxin-induced myocardial dysfunction cases, such as caffeine toxicity. The success implies potential for broader applications of HIET in cardiogenic shock scenarios not directly related to typical cardiotoxic drugs.

Keywords

caffeine overdose

cardiac arrest

High-Dose Insulin Euglycemic Therapy

HIET

neurological recovery

microvascular recruitment

myocardial metabolism

cardiogenic shock

toxin-induced myocardial dysfunction

resuscitation