Polarizing mixture in cardiometabolic diseases: history and prospects

In 1962, in the American Journal of Cardiology, a group of authors led by D. Sodi-Pallares reported that the use of a mixture of glucose, insulin and potassium – a «polarizing mixture» (PM) in patients with myocardial ischemia is accompanied by positive changes in the electrocardiogram. Further clinical observations confirmed the presence of a certain benefit from the use of this metabolic cocktail in patients with acute myocardial infarction (MI). It was believed that perfusion of anoxic heart cells with solutions with an increased content of glucose, insulin and potassium enhances the contractile function of the myocardium. In experimental and first clinical studies, it was shown that intravenous administration of the PM helps to reduce the size of MI and reduce hospital mortality rates. Since then, many large randomized trials have been published that have studied the role of PM in the treatment of MI, but their results have not been as optimistic and unanimous. The article presents the pathogenetic mechanisms of action of PM and analyzes the results of studies on the use of PM in patients with cardiometabolic diseases. The indications and features of the use of this mixture in clinical practice are discussed. Conclusions. Clinical recommendations for the use of PM in cardiometabolic diseases remain somewhat controversial. Today, the administration of PM can be recommended in the following clinical situations: 1) Perioperative period during cardiac surgery; 2) Arrhythmias caused by hypokalemia, including intoxication with cardiac glycosides; 3) Severe hypokalemia (serum potassium concentration less than 2.5 mmol/l); 4) Acute myocardial infarction in patients with type 2 diabetes mellitus. It should also be noted that the dosage regimen of PM for a particular patient should be established individually, with careful monitoring of the electrocardiogram and serum potassium levels.