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...
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| Format: | Article |
| Language: | English |
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Wiley
2011-01-01
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| Series: | Critical Care Research and Practice |
| Online Access: | http://dx.doi.org/10.1155/2011/361737 |
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| author | Martyn Harvey Grant Cave Daniel Lahner Jan Desmet Gaynor Prince Gary Hopgood |
| author_facet | Martyn Harvey Grant Cave Daniel Lahner Jan Desmet Gaynor Prince Gary Hopgood |
| author_sort | Martyn Harvey |
| collection | DOAJ |
| 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 | Article |
| id | doaj-art-0d4ff939703e45c69a1d569157612aa9 |
| institution | Kabale University |
| issn | 2090-1305 2090-1313 |
| language | English |
| publishDate | 2011-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Critical Care Research and Practice |
| spelling | doaj-art-0d4ff939703e45c69a1d569157612aa92025-02-03T00:59:34ZengWileyCritical Care Research and Practice2090-13052090-13132011-01-01201110.1155/2011/361737361737Insulin versus Lipid Emulsion in a Rabbit Model of Severe Propranolol Toxicity: A Pilot StudyMartyn Harvey0Grant Cave1Daniel Lahner2Jan Desmet3Gaynor Prince4Gary Hopgood5Department of Emergency Medicine, Waikato Hospital, Pembroke Street, Hamilton 3204, New ZealandEmergency Department, Hutt Hospital, High Street, Lower Hutt 5011, New ZealandDepartment of Emergency Medicine, Waikato Hospital, Pembroke Street, Hamilton 3204, New ZealandDepartment of Emergency Medicine, Waikato Hospital, Pembroke Street, Hamilton 3204, New ZealandDepartment of Emergency Medicine, Waikato Hospital, Pembroke Street, Hamilton 3204, New ZealandDepartment of Anesthesia, Waikato Hospital, Pembroke Street, Hamilton 3204, New ZealandBackground 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.http://dx.doi.org/10.1155/2011/361737 |
| spellingShingle | Martyn Harvey Grant Cave Daniel Lahner Jan Desmet Gaynor Prince Gary Hopgood Insulin versus Lipid Emulsion in a Rabbit Model of Severe Propranolol Toxicity: A Pilot Study Critical Care Research and Practice |
| 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 |
| url | http://dx.doi.org/10.1155/2011/361737 |
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