Jolliet P, Leverve X, Pichard C
Medical ICU Division, University Hospital, Geneva, Switzerland.
Intensive Care Med. 2001 Jan;27(1):313-6. doi: 10.1007/s001340000763.
To describe a case of acute hepatic steatosis due to excessive administration of glucose in the setting of massive insulin overdose, a complication which is rapidly and completely reversible if glucose infusion is rapidly tapered.
Case report, clinical.
Intensive care unit, university hospital.
A single patient admitted to the ICU.
Intravenous glucose after insulin overdose.
On the 3rd day, increases in transaminase (ASAT 420 IU/l, ALAT 610 IU/l), bilirubin (147 mmol/l) and lactate (6.8 mmol/l), a decrease in arterial pH (7.32) and slightly increased liver size on ultrasound examination suggested acute hepatic steatosis. Clinical and laboratory abnormalities resolved rapidly after discontinuation of excessive glucose infusions (1,400 g/day for 3 days).
Very large amounts of glucose after massive insulin overdose are potentially dangerous. Even though the fear of hypoglycemia-induced neurologic damage should be a constant preoccupation in this situation, glucose administration should be titrated on closely monitored blood glucose levels.
描述一例在大量胰岛素过量情况下因过量输注葡萄糖导致的急性肝脂肪变性病例，该并发症若能迅速减少葡萄糖输注量则可迅速且完全逆转。
临床病例报告。
大学医院重症监护病房。
一名入住重症监护病房的患者。
胰岛素过量后静脉输注葡萄糖。
第3天，转氨酶（谷草转氨酶420 IU/L，谷丙转氨酶610 IU/L）、胆红素（147 mmol/L）和乳酸（6.8 mmol/L）升高，动脉血pH值降低（7.32），超声检查显示肝脏大小略有增加，提示急性肝脂肪变性。在停止过量葡萄糖输注（3天内每天1400克）后，临床和实验室异常迅速消失。
大量胰岛素过量后输注极大量葡萄糖具有潜在危险性。尽管在这种情况下应始终关注低血糖诱发神经损伤的问题，但葡萄糖输注应根据密切监测的血糖水平进行调整。
