High Insulin-Dextrose - Euglycaemia Therapy (HIET)

Introduction

novel treatment for calcium channel blocker OD, can be considered in beta-blocker OD
considered if refractory to IV fluids, calcium and inotropic support
insulin has inotropic effect on heart - may take 20-30minutes to start after high dose bolus

usual adult regime:
- dextrose bolus 25 g (50ml of 50%)
- short acting insulin 1 International Unit/kg IV bolus
- then 0.5g/kg/hour Dextrose and short acting insulin 0.5-1.0 IU/kg/hour
monitor glucose every 30 minutes and potassium every hour
- must maintain euglycaemia
- hypokalaemia may occur
if fluid overload is a possibility, use 10U/mL concentration of insulin
consider monitoring cardiac EF via bedside echo before and at 30-60min to see if it is helping