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High-dose insulin euglycaemia therapy (HIET) dosing
Regular-insulin bolus and infusion for calcium-channel or beta-blocker toxicity.
High-dose insulin euglycaemia therapy (HIET) dosing
Body weight
kg
Infusion rate (regular insulin)
Start ~0.5-1 U/kg/hr and titrate up to 10 U/kg/hr for haemodynamic response.
Complete the fields above to see the result.
When to use
- Cardiogenic shock from calcium-channel-blocker or beta-blocker poisoning not responding to standard measures.
Formula
Bolus = 1 U/kg regular insulin IV. Infusion = weight (kg) x rate (0.5-10 U/kg/hr). Titrate to blood pressure and cardiac output.
Pearls and pitfalls
- Start a concurrent dextrose infusion; check glucose every 15-30 min initially and replace potassium as it shifts intracellularly.
- Inotropic effect is delayed 15-60 min, so give it early rather than as a last resort.