| Download the amazing global Makindo app: ✅ Means NICE/National Guidelines 2026 compliant Android | Apple | |
|---|---|
| MEDICAL DISCLAIMER: Educational use only. Not for diagnosis or management. See below for full disclaimer. |
Hyperinsulinaemic-euglycemic therapy (HIET)
🚨 Hyperinsulinaemic–Euglycaemic Therapy (HIET) is an evidence-based rescue therapy for severe calcium channel blocker (CCB) and beta-blocker (BB) overdose. It improves cardiac contractility and perfusion without increasing myocardial oxygen demand.
📖 About
- Used in refractory CCB and BB toxicity, especially when conventional therapy (fluids, atropine, glucagon, catecholamines) fails.
- Now considered routine adjunctive therapy in toxicology and critical care settings (ITU/HDU).
⚠️ Side Effects / Monitoring
- Hypoglycaemia 🍬: Insulin drives glucose into cells → continuous glucose infusion needed.
- Hypokalaemia 🔻K⁺: Intracellular shift of potassium; replace if severe.
- Hypomagnesaemia / Hypophosphataemia: May occur, monitor electrolytes closely.
- Requires hourly glucose and electrolyte checks in ITU/HDU setting.
🧬 Mechanism
- Insulin enhances myocardial carbohydrate uptake and utilisation, improving ATP availability.
- Promotes excitation–contraction coupling and increases inotropy without raising oxygen demand. 🫀
- Benefits:
- Independent of catecholamine signalling → works even in β-blockade.
- Improves contractility 💪 but not chronotropy (does not increase HR).
- May cause vasodilation - best used alongside vasopressors if hypotension persists.
💉 Dose (HIET Protocol)
- Loading:
- Give 50 mL of 50% dextrose IV (25 g glucose).
- Administer insulin bolus: 1 unit/kg IV.
- Infusion:
- Dextrose: 50% solution at ~2 mL/kg/hr (≈1 g/kg/hr).
- Insulin: Continuous infusion at 1 unit/kg/hr IV.
- Titrate infusion depending on clinical response.
- Duration: Continue until haemodynamic stability is restored; may need glucose infusion after stopping insulin to avoid rebound hypoglycaemia.
- Setting: Must be delivered in ITU/HDU with invasive monitoring.
📚 References
| The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms. |
|
|
Categories
- A Level
- About
- Acute Medicine
- Anaesthetics and Critical Care
- Anatomy
- Anatomy and Physiology
- Biochemistry
- Book
- Cardiology
- Collections
- CompSci
- Crib Sheets
- Dental
- Dermatology
- Differentials
- Drugs
- ENT
- Education
- Electrocardiogram
- Embryology
- Emergency Medicine
- Endocrinology
- Ethics
- Foundation Doctors
- GCSE
- Gastroenterology
- General Practice
- Genetics
- Geriatric Medicine
- Guidelines
- Gynaecology
- Haematology
- Hepatology
- Immunology
- Infectious Diseases
- Infographic
- Investigations
- Lists
- MRCP
- Mandatory Training
- Medical Students
- Microbiology
- Nephrology
- Neu
- Neurology
- Neurosurgery
- Nutrition
- OSCE
- OSCEs
- Obstetrics
- Obstetrics Gynaecology
- Oncology
- Ophthalmology
- Oral Medicine and Dentistry
- Orthopaedics
- Paediatrics
- Palliative
- Pathology
- Pharmacology
- Physiology
- Procedures
- Psychiatry
- Public Health
- Radiology
- Renal
- Respiratory
- Resuscitation
- Revision
- Rheumatology
- Statistics and Research
- Stroke
- Surgery
- Toxicology
- Trauma and Orthopaedics
- USMLE
- Urology
- Vascular Surgery