cliot (version 1.0.0)

hiet_dosing: High-Dose Insulin Euglycemia Therapy (HIET) Dosing

Description

Calculates the initial dosing for High-Dose Insulin Euglycemia Therapy (HIET), used in the management of severe Calcium Channel Blocker (CCB) and Beta Blocker (BB) toxicity. The protocol includes an insulin bolus and infusion to improve cardiac contractility, alongside dextrose supplementation to maintain euglycemia.

Usage

hiet_dosing(weight_kg, serum_glucose_initial, insulin_bolus_dose_u_kg = 1,
            insulin_drip_rate_u_kg_hr = 0.5, dextrose_bolus_g_kg = 0.5,
            dextrose_drip_g_kg_hr = 0.5)

Value

A list containing:

Insulin_Bolus_Units

The calculated insulin bolus dose in Units.

Insulin_Drip_Units_hr

The calculated insulin infusion rate in Units per hour.

Dextrose_Bolus_Grams

The calculated dextrose bolus in grams (0 if glucose >= 200).

Dextrose_Maintenance_Grams_hr

The calculated dextrose maintenance infusion rate in grams per hour.

Arguments

weight_kg

Numeric. Patient weight in kilograms.

serum_glucose_initial

Numeric. Initial serum glucose level in mg/dL. Used to determine if a Dextrose bolus is required (glucose < 200 mg/dL).

insulin_bolus_dose_u_kg

Numeric. Bolus dose of Regular Insulin in Units/kg. Defaults to 1 U/kg.

insulin_drip_rate_u_kg_hr

Numeric. Infusion rate of Regular Insulin in Units/kg/hr. Defaults to 0.5 U/kg/hr.

dextrose_bolus_g_kg

Numeric. Bolus dose of Dextrose (e.g., D50) in g/kg. Administered only if initial glucose < 200 mg/dL. Defaults to 0.5 g/kg.

dextrose_drip_g_kg_hr

Numeric. Initial dextrose infusion rate in g/kg/hr. Defaults to 0.5 g/kg/hr.

References

Greene SL, Gawarammana I, Wood DM, et al. Relative safety of hyperinsulinemia/euglycemia therapy in the management of calcium channel blocker overdose: a prospective observational study. Intensive Care Med. 2007;33(11):2019-2024. doi:10.1007/s00134-007-0792-8

Examples

# Example 1: Hypoglycemic/Euglycemic patient (Glucose 150)
# 70kg patient
# Insulin Bolus: 70 U, Drip: 35 U/hr
# Dextrose Bolus: 35g, Drip: 35g/hr
hiet_dosing(70, 150)

# Example 2: Hyperglycemic patient (Glucose 250)
# 80kg patient
# Insulin Bolus: 80 U, Drip: 40 U/hr
# Dextrose Bolus: 0g (Skipped), Drip: 40g/hr
hiet_dosing(80, 250)