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

Language: Spanish
References: 42
Page: 335-341
PDF size: 559.86 Kb.

ABSTRACT

Insulin is an essential hormone for the control of glucose. Its pleyotropic effects are mediated by a series of intracellular signaling pathways. Cardiovascular effects of insulin include the action upon the energetic metabolism, inotropic and vasodilator effects as well as the ionic transport and cardiac protection. The inotropic effect of an insulin infusion at high doses (1-10 u/kg/h) is secondary to the increased supply of glucose to the myocytes, decreased levels of free fatty acids, effect on Na/K-ATPase pump, improvement in the intracellular movement of calcium and the activation of the phosphatidylinositol-3-phosphate pathway. The aim of this paper is to report a case of refractory right ventricular failure which responded to the infusion of insulin at high doses, and review the literature related to the inotropic effect of insulin. Case report: 44 year old patient with a history of non-Hodgkin large B-cell lymphoma and cardiomyopathy secondary to anthracycline. Admitted to the Intensive Care Unit (ICU) for severe sepsis and septic shock. During her stay in the ICU she developed right-sided heart failure that led her to cardiogenic shock that was refractory to treatment with inotropic and vasopressor agents. We started a treatment consisting of insulin infusion at a dose of 1 u/kg/h, showing a significant improvement in the right ventricular dysfunction, reversing shock and improving systemic perfusion. The diminishment of inotropic and vasopressor agents was achieved.
Conclusion: The inotropic effect of insulin is mediated by different mechanisms. The implementation of insulin infusions at high doses in different clinical scenarios associated with cardiac dysfunction is a promising new therapeutic alternative.

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