hyperinsulinemic euglycemia therapy for acute nitroglycerin poisoning: case report

Nitroglycerin, a vasodilator, is commonly administered to treat ischemic heart disease. adverse effects after toxicity are light-headedness, nausea, blurry vision, and syncope due to low systolic blood pressure as well as methemoglobinemia. a 19-year-old female was admitted to our toxicology department after suicidal ingestion of 320 mg extended-release nitroglycerin about 45 minutes before the admission. she was conscious, and her initial blood pressure was 98/65 mm hg, which was decreased to 77 mmhg within 1.5 hours despite administration of 1 liter of normal saline. due to severe hypotension, norepinephrine infusion was started for systolic blood pressure maintenance above 80mm hg; however, she started complaining of palpitation and chest pain. so, the dose of norepinephrine was reduced, and glucose, insulin, and potassium protocol were started. after 3 hours of therapy, her hemodynamic condition stabilized with systolic blood pressure above 90mm hg; hence norepinephrine was discontinued. she was discharged on the 3rd day after the psychiatric consultation, with regular clinical and paraclinical examinations.