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The treatment for both CCB and BB toxicity is similar. ABCs should always be assessed first and addressed appropriately. If patients are evaluated within one hour, activated charcoal can be administered. IV fluids and atropine are given to treat hypotension and bradycardia. Patients should then be given IV glucagon and calcium salts. If patients remain hypotensive vasopressors can be started. If the patient is refractory to these interventions, high dose insulin therapy should be considered and utilized. Typical treatment may not be effective because glucagon has a transient increase in inotropy but is not maintained, vasopressors increase systemic vascular resistance which can decrease cardiac output, and perfusion and atropine is short lived. Considering failure of these

treatments, increasing evidence demonstrates that patients may have better outcomes with administration of HDI. Insulin has positive inotropic properties while being inexpensive with a minimal adverse

effect profile. The mechanism of action is not well defined but it is theorized that during shock myocardium utilizes glucose as a substrate for energy instead of free fatty acids and insulin increases intracellular glucose transport in the myocardium. HDI also produces vasodilation, which improves systemic perfusion.