Abstract
Background: Acute poisonings remain a major problem in many countries. Timely and effective treatment is important in minimizing the mortalities associated with acute poisonings.
Methods: A Medline search of literature reports relating to insulin euglycemic therapy, intravenous lipid emulsion (ILE), and extracorporeal life support (ECLS) was conducted and summarized.
Results: Insulin euglycemic therapy was mainly used in the management of beta-blocker and calcium channel blocker poisonings and the mechanisms underlying the therapy include increased inotropy, increased intracellular glucose transport, and vascular dilatation. Both animal studies and numerous case reports suggest that high dose insulin is superior to conventional treatments. The usefulness of ILE in human poisonings was first reported in a patient with bupivacaine related cardiac arrest in 2006. In the past 5 years, many severely poisoned cases receiving ILE were reported and the major mechanism underlying ILE is the “lipid sink” theory. Although there are no published controlled trials (RCTs) on ILE, it seems that ILE maybe useful in patients manifesting life-threatening cardiotoxicity from lipophilic toxicants. The application of ECLS in poisoned patients is rarely reported. In a recently reported study, 2/14 (86%) patients receiving ECLS survived, as compared to 23/48 (48%) patients without ECLS (p= 0.02). Given the limited reports, ECLS may benefit patients with hemodynamic instability not responding to conventional measures.
Conclusions: Limited literature reports suggest that several new treatments may be effective in rescuing severely poisoned patients. Well-designed multicenter prospective cohorts studies and/or RCTs are urgently needed to better understand the effectiveness of such treatments.
