Glogan Diane, Levitan Rachel D, Brooks Daniel E, Gerkin Richard D
Banner Good Samaritan Poison Control and Drug Information Center, Phoenix, Arizona.
J Emerg Med. 2013 Oct;45(4):547-53. doi: 10.1016/j.jemermed.2013.01.032. Epub 2013 May 15.
There are no guidelines for the management of accidental insulin administration. We hypothesized that home monitoring of asymptomatic patients (pts) was safe following unintentionally insulin administration.
Retrospective review of poison center (PCC) charts from 1/1/2000-12/31/2010 looking for accidental insulin administrations.
pt must be prescribed insulin. Information recorded from charts: pt age/gender, "intended" and "mistaken" insulin formulations/doses, use of oral diabetic agents, management site, Emergency Department (ED) referral, symptoms, blood glucose values, and treatments. Defined outcomes: symptoms (e.g., altered sensorium); hypoglycemia (<60 mg/dL); management site; health care facility (HCF) admission; and death. Multiple logistic regression was used to determine outcome predictors.
652 charts met inclusion criteria. Mean age was 56.4 years; most (58.5%) were women. Most (89%) calls originated from home, 10.7% from a HCF, 0.3% from Emergency Medical Services (EMS). Overall, 397 (60.9%) pts were managed at home. Two pts managed at home were later evaluated by EMS; neither required admission. Symptoms developed in 56 (8.6%) pts. There were no deaths. Only 40 (6.1%) pts were admitted to a HCF; 18 (45%) pts were hypoglycemic. The development of hypoglycemia (odds ratio [OR] 5.94; p < 0.001) and amount of insulin accidentally administered (OR 1.04; p < 0.001) predicted HCF referral. The type and dose of insulin administered did not predict symptoms.
Based on a retrospective analysis of a single PCC's cases, home observation of asymptomatic patients after unintentional administration of a wrong insulin formulation appears safe.
目前尚无意外注射胰岛素的管理指南。我们推测，无症状患者在意外注射胰岛素后进行家庭监测是安全的。
回顾性分析2000年1月1日至2010年12月31日中毒控制中心（PCC）的图表，以查找意外注射胰岛素的情况。
患者必须已开具胰岛素处方。从图表中记录的信息：患者年龄/性别、“预期”和“错误”的胰岛素制剂/剂量、口服降糖药的使用情况、处理地点、急诊科（ED）转诊情况、症状、血糖值和治疗方法。定义的结果：症状（如意识改变）；低血糖（<60mg/dL）；处理地点；医疗机构（HCF）收治；以及死亡。采用多元逻辑回归分析来确定结果预测因素。
652份图表符合纳入标准。平均年龄为56.4岁；大多数（58.5%）为女性。大多数（89%）的呼叫来自家中，10.7%来自医疗机构，0.3%来自紧急医疗服务（EMS）。总体而言，397例（60.9%）患者在家中接受处理。在家中接受处理的2例患者后来由EMS进行了评估；均无需收治。56例（8.6%）患者出现了症状。无死亡病例。仅40例（6.1%）患者被收治到医疗机构；18例（45%）患者发生低血糖。低血糖的发生（比值比[OR]5.94；p<0.001）和意外注射的胰岛素量（OR 1.04；p<0.001）可预测医疗机构转诊情况。所注射胰岛素的类型和剂量不能预测症状。
基于对单个PCC病例的回顾性分析，意外注射错误胰岛素制剂后对无症状患者进行家庭观察似乎是安全的。
