see [Murray high dose insulin](x-devonthink-item://C8AE745C-C96E-4AEF-9010-D441840C6DF4?page=435) # indications 1st line for [[Calcium channel blocker overdose]] 2ne line for [[beta blocker overdose]] # Mechanism of action - insulin **ionotropic effect** on heart - increases lactate oxidate and eliminates myocardial fatty acid oxidation - optimises heart function under stress conditions - glucose given simultaneously to maintain euglycaemia - increased ionotropy - increased intracellular glucose transport and vascular dilation **does NOT act as a vasopressor or a chronotrope** takes ~ 45 min to start working # Dose **Loading:** - 50mL of 50% dextrose bolus (25g), then - actrapid 1unit/kg bolus > if blood glucose is >15 mmol/L, bolus not required **Maintenance:** - glucose 25g/hour - insulin 0.5 units/kg/hour IV infusion, can titrate up to max of 10 units/kg/hour (yes, this is WAY higher thank DKA protocol) > check glucose and K every 15 min initially > - replace K if <2.5 ; if replacing too high then get rebound hyperkalemia ## paeds dose 2.5 mL/kg of 10% dex slow IV bolus followed by infusion of 3-5mL/kg/hour of 10% dextrose ==insulin is safe in pregnancy==