Carolinas Poison Center, Carolinas Medical Center , Charlotte, NC , USA.
Clin Toxicol (Phila). 2013 Sep-Oct;51(8):789-93. doi: 10.3109/15563650.2013.829236. Epub 2013 Aug 22.
Insulin dosing errors are one of the most dangerous medication issues due to the risk of profound hypoglycemia. The incidence of insulin dosing errors is increasing and there is no standard of care for management location.
To determine the types of insulin, follow-up time, number of phone calls, incidence of hypoglycemia, and case outcomes for unintentional insulin overdoses managed by Poison Centers (PCs).
Observational case series: records of patients with unintentional injected insulin errors from three PCs over a 22-month period were manually reviewed for insulin type, management site, time of exposure, insulin dose, number of calls, presence of hypoglycemia, and case outcome.
There were 642 cases: 97.5% occurred in the home and the majority of patients (77.3%) were managed on site with only 17.4% resulting in Emergency Department treatment. Clinical or numerical (blood sugar < 60 mg/dL) hypoglycemia occurred 15.9% (n = 102) of the time in all cases, with 6.9% (n = 41) of cases having numerical hypoglycemia. The median insulin dose when known was 40 Units, with short-acting insulin making up the majority of cases (64.3%) with 13.8% of cases having a dose error of 80 or more units. The average duration of follow-up was 6.9 h. The frequency of hypoglycemia (clinical or numerical) did not differ between short and non-short duration insulin cases (15.7% vs. 16.9%, n = 65 vs. 37, p = 0.91), did not differ with cases receiving more than 50 Units of insulin (14.9% vs. 16.7%, n = 29 vs. 73, p = 0.64), and did not differ between those managed on site and other management locations (14.4% vs. 21.4%, n = 71 vs. 31, p = 0.053). Outcomes were benign in the majority of cases and there were no cases with Major (severe) outcomes or Death.
Insulin dosing accidents can be routinely managed at home by PCs and have a low rate of hypoglycemia and adverse outcomes. This suggests that these cases can often be managed at home without referral with a potential benefit in no direct cost to the patient, convenience, and immediacy.
胰岛素给药错误是最危险的药物问题之一，因为有发生严重低血糖的风险。胰岛素给药错误的发生率正在上升，且管理地点尚无标准的护理方法。
确定中毒控制中心（PC）管理的非故意胰岛素过量患者的胰岛素类型、随访时间、电话次数、低血糖发生率和病例结果。
观察性病例系列研究：对三个 PC 在 22 个月期间记录的非故意注射胰岛素错误患者的记录进行手动审查，以了解胰岛素类型、管理地点、暴露时间、胰岛素剂量、电话次数、低血糖的发生情况以及病例结果。
共记录了 642 例患者：97.5%的事件发生在家中，大多数患者（77.3%）在现场接受管理，只有 17.4%的患者需要到急诊科治疗。所有病例中有 15.9%（n=102）出现临床或血糖数值（<60mg/dL）低血糖，其中 6.9%（n=41）的病例有血糖数值低血糖。已知的胰岛素剂量中位数为 40 单位，短效胰岛素占大多数（64.3%），有 13.8%的病例胰岛素剂量错误 80 个单位以上。平均随访时间为 6.9 小时。低血糖（临床或数值）的发生率在短时间和非短时间胰岛素病例之间没有差异（15.7%比 16.9%，n=65 比 37，p=0.91），与接受 50 单位以上胰岛素的病例也没有差异（14.9%比 16.7%，n=29 比 73，p=0.64），且与现场和其他管理地点的病例也没有差异（14.4%比 21.4%，n=71 比 31，p=0.053）。大多数病例的结局是良性的，且没有严重（严重）结局或死亡的病例。
PC 可在家中常规管理胰岛素给药错误，低血糖和不良结局的发生率较低。这表明，这些情况通常可以在家中管理，无需转介，且对患者没有直接费用、方便且及时。
