Department of Medicine, NorthShore University HealthSystem-Evanston Hospital, Evanston, IL, USA.
Am J Ther. 2011 Sep;18(5):e162-6. doi: 10.1097/MJT.0b013e3181f4eadb.
We present a case of a significant insulin overdose that was managed by monitoring daily plasma insulin levels. A 39-year-old male with poorly controlled diabetes mellitus presented to the Emergency Department via emergency medical services after an attempted suicide by insulin overdose. In the attempted suicide, he injected 800 U of insulin lispro and 3800 U of insulin glargine subcutaneously over several parts of his abdomen. The patient was conscious upon arrival to the emergency department. His vital parameters were within normal range. The abdominal examination, in particular, was nonfocal and showed no evidence of hematomas. He was awake, alert, conversant, tearful, and without any focal deficits. An infusion of 10% dextrose was begun at 100 mL/h with hourly blood glucose (BG) checks. The patient was transferred to the intensive care unit where his BG began to decrease and fluctuate between 50 and 80 mg/dL, and the rate of 10% dextrose was increased to 200 mL/h where it was maintained for the next 48 hours. The initial plasma insulin level was found to be 3712.6 uU/mL (reference range 2.6-31.1 uU/mL). At 10 hours, this had decreased to 1582.1 uU/ml. On five occasions, supplemental dextrose was needed when the BG was <70 mg/dL. Thirty-four hours after admission, the plasma insulin level was 724.8 uU/mL. Fifty-eight hours after admission, the plasma insulin level was 321.2 uU/mL, and the 10% dextrose infusion was changed to 5% dextrose solution at 200 mL/h. The plasma insulin levels continued to fall daily to 112.7 uU/mL at 80 hours and to 30.4 uU/mL at 108 hours. He was transferred to an inpatient psychiatric facility 109 hours after initial presentation. Monitoring daily plasma insulin levels and adjusting treatment on a day-to-day basis in terms of basal glucose infusions provides fewer opportunities for episodic hypoglycemia. Furthermore, it was easier to predict daily glucose requirements and eventual medical clearance based on the plasma levels.
我们报告了一例因胰岛素过量而接受监测日常血浆胰岛素水平管理的病例。一名 39 岁男性患有未控制的糖尿病，因胰岛素过量自杀未遂后通过紧急医疗服务被送往急诊部。在自杀未遂中，他将 800U 赖脯胰岛素和 3800U 甘精胰岛素皮下注射到腹部的几个部位。患者到达急诊部时意识清醒。他的生命体征在正常范围内。腹部检查，特别是没有发现焦点，也没有发现血肿的证据。他意识清醒、警觉、健谈、流泪，没有任何局灶性缺陷。开始以 100mL/h 的速度输注 10%葡萄糖，并每小时检查一次血糖（BG）。患者被转至重症监护病房，BG 开始下降，波动在 50-80mg/dL 之间，10%葡萄糖的输注速度增加至 200mL/h，在接下来的 48 小时内维持这一速度。发现初始血浆胰岛素水平为 3712.6uU/mL（参考范围 2.6-31.1uU/mL）。10 小时后，该值下降至 1582.1uU/ml。在 BG<70mg/dL 的 5 次情况下，需要补充葡萄糖。入院后 34 小时，血浆胰岛素水平为 724.8uU/mL。入院后 58 小时，血浆胰岛素水平为 321.2uU/mL，将 10%葡萄糖输注液更改为 200mL/h 的 5%葡萄糖溶液。血浆胰岛素水平继续每天下降，在 80 小时时降至 112.7uU/mL，在 108 小时时降至 30.4uU/mL。他在最初出现 109 小时后被转至住院精神病院。每天监测血浆胰岛素水平，并根据基础葡萄糖输注量每天调整治疗，这可减少低血糖发作的机会。此外，根据血浆水平更容易预测每日血糖需求和最终的医疗清除率。
