Hyperinsulinemic-euglycemic therapy for intoxication with calcium channel blockers

Conventional therapy for intoxication with calcium channel blockers consists of crystalloid solutions, calcium gluconate, glucagon and vasopressor agents. These therapies often fail to improve hemodynamic function in intoxicated patients. The pathophysologic mechanism proposed for intoxication with these agents, suggest hypoinsulinemia as the determinant factor. We will describe the case of a 77 years old man treated for an overdose of nifedipine and atenolol who arrived at our institution with hypotension and bradycardia. After conventional therapy failed to improve the patient's hemodynamic status, hyperinsulinemia and euglycemia contributed to the improvement of the patient's neurologic and hemodynamic condition. Thus, hyperinsulinemic-euglycemic therapy was of benefit in this patient with hemodynamic compromise secondary to intoxication with calcium channel blocker not responding to conventional therapy. We will review the mechanism of action of calcium channel blocker drugs as well as the clinical presentation and treatment options for calcium channel blocker intoxication.

Knowledge and attitudes about AIDS among staff of community-based health and social service organizations in the Southwest: implications for staff training.

To ascertain the specific AIDS training needs of staff from community-based organizations in the Southwest, a survey of knowledge and attitudes was conducted by the National Coalition of Hispanic Health and Human Services Organizations (COSSMHO) in the 5 Southwestern cities of Albuquerque, El Paso, Phoenix, San Diego, and Tucson. The responses of 1057 staff were examined according to staff position: managerial, direct service, clerical, and volunteer. Staff were 60.3% Hispanic/Latino and 28.4% white non-Hispanic. Staff responses were examined on 3 dimensions of AIDS-related knowledge and on 3 attitudinal dimensions. A multivariate analysis of covariance (MANCOVA) that controlled for 4 sources of group nonequivalence revealed generally that managers and direct service staff had higher knowledge and more favorable attitudes than did clerical and volunteer staff. Of greatest concern, however, was the number of specific knowledge items for which all staff obtained less than 80% correct answers. Disturbing knowledge deficits exist on important AIDS-related information across all levels of staff. Specific content and strategies are presented for corrective interventions by staff type.