Diltiazem overdose: a role for high-dose insulin.

A 62-year-old man presented 6 h after a mixed intentional overdose of dilatizem (Adizem-SR), atorvastatin, aspirin and isosorbide mononitrate. He was symptomatic, with vomiting, blurred vision and unsteady gait. Despite initial fluid resuscitation and calcium chloride, glucagon, and high-dose ionotropic therapy, his hypotension remained refractory to treatment. A bolus of high-dose insulin (Actrapid) was administered, followed by a continuous infusion. Glucose was administered to maintain a state of euglycaemia. Over the following 24 h, the patient was given 1140 units of accumulative insulin. This resulted in a significant improvement in arterial blood pressure values and metabolic indices, allowing contiguous weaning off inotropes. This case supports the use of rescue hyperinsulinaemic euglycaemia in patients with an overdose of calcium channel blockers who remain hypotensive despite standard pharmacological measures.

[Case of severe rhabdomyolosis after protracted overdose of simvastatin]. / Et tilfaelde af svaer rabdomyolyse efter laengerevarende overdosering med simvastatin.

The mechanisms of statin-induced muscle injury are not fully understood, and early recognition of statin myopathy is critical in order to prevent serious sequelae. The case of a 57-year-old woman who had accidentally taken a quadrupled dose of simvastatin over a period of 18 days is presented. The patient was admitted to hospital with severe rhabdomyolysis and treated with forced diuresis. Despite the rhabdomyolysis, the patient's kidney function was not affected, but reduced muscle function was observed which was still not fully regained 6 months later.