Carrillo-Esper R, Peña-Pérez C, Carrillo-Córdova LD, Carrillo-Córdova CA, Carrillo-Córdova DM, García-de Alba GP

Idioma: Español
Referencias bibliográficas: 42
Paginas: 335-341
Archivo PDF: 559.86 Kb.

RESUMEN

La insulina es una hormona fundamental para el control de la glucosa que tiene efectos pleiotrópicos mediados por vías de señalización intracelulares. Los efectos cardiovasculares de la insulina incluyen: acción en el metabolismo energético, efecto inotrópico y vasodilatador, transporte iónico y cardioprotección. El efecto inotrópico de la infusión de insulina a dosis altas (1-10 u/ kg/h) es secundario al incremento en el aporte de glucosa al miocito, disminución de las concentraciones de ácidos grasos libres, efecto en la bomba de Na/K-ATPasa, mejoría del movimiento del calcio intracelular y activación de la vía del fosfatidilinositol-3-fosfato. El objetivo de este trabajo es reportar un caso de insuficiencia ventricular derecha resistente que reaccionó a la infusión de insulina a dosis elevadas y revisar la bibliografía relacionada con el efecto inotrópico de la insulina.
Caso clínico: paciente femenina de 44 años de edad, con antecedentes de linfoma no Hodgkin de células grandes tipo B y cardiomiopatía secundaria a antracíclicos. Ingresó a la unidad de terapia intensiva por sepsis grave y choque séptico. Durante su estancia tuvo insuficiencia cardiaca derecha que la llevó a choque cardiogénico y que fue resistente al tratamiento con inotrópico y vasopresores. Se inició tratamiento con infusión de insulina a dosis de 1 U/kg/h, con lo que hubo mejoría significativa de la disfunción ventricular derecha, revirtiendo el estado de choque y mejorando la perfusión sistémica. Se disminuyó y suspendió la infusión de inotrópico y vasopresores.
Conclusión: el efecto inotrópico de la insulina es mediado por diferentes mecanismos. La infusión de insulina a dosis elevadas en diferentes escenarios asociados con la disfunción cardiaca es una nueva y promisoria alternativa terapéutica.

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