A Sweet Solution to a Fatty Problem: Intravenous Insulin in Severe Hypertriglyceridemia

As therapeutic and cosmetic applications of botulism neurotoxin (BoNT) continue to expand, the risk of a patient presenting with iatrogenic botulism is increasing. This man-made form of botulism results from the unintended spread of the toxin, leading to clinical manifestations mirroring traditional botulism. These cases require timely recognition and prompt intervention to prevent progression to life-threatening neuromuscular paralysis and respiratory compromise. Although supportive care remains the cornerstone of initial therapy, botulism antitoxin (BAT) plays a critical role in management, with approximately 20% of documented cases requiring administration. BAT contains antibody fragments that bind and neutralize circulating botulinum neurotoxin, thus halting further progression of paralysis. However, the antitoxin cannot bind to neurotoxin that has already entered the nerve terminals and is bound to them, making early treatment crucial. When administered within 2 days of symptom onset, BAT was shown to be safe, and it was associated with shorter hospital and intensive care unit length of stays. Pharmacist led coordination has also been shown to expedite acquisition, preparation, and administration of BAT, facilitating interdisciplinary care and supporting safe administration handling. This presentation will quickly review evidence-based treatment options for iatrogenic botulism, highlight key decision points regarding BAT administration, and provide practical guidance for clinicians managing this rare but serious toxin-related complication.