Fujisaki Noritomo, Kosaki Yoshinori, Nojima Tsuyoshi, Higaki Taiki, Yamada Taihei, Koga Hitoshi, Gochi Akira, Naito Hiromichi, Nakao Atsunori
Department of Emergency Critical Care and Disaster Medicine Okayama University Okayama-city Okayama Japan.
Department of Emergency Medicine St Maria Hospital Kurume-city Fukuoka Japan.
J Am Coll Emerg Physicians Open. 2020 May 25;1(5):1097-1100. doi: 10.1002/emp2.12093. eCollection 2020 Oct.
Patients with poorly controlled insulin-dependent type 1 or type 2 diabetes rarely present with glycogenic hepatopathy, which is characterized by hepatomegaly and liver enzyme abnormalities. Glycogenic hepatopathy occurs as a consequence of excessive accumulation of glycogen in hepatocytes caused by insulin. We report a young male patient with type 1 diabetes mellitus who developed glycogenic hepatopathy following a suicide attempt by insulin overdose via subcutaneous injection. The patient's medication/nutrition compliance and adherence to insulin were poorly controlled due to comorbid schizophrenia. Our patient required a large amount of continuous glucose to maintain euglycemia for persistent intractable hypoglycemia induced by overdose of long-acting insulin. On admission day 4, the patient presented elevated transaminases, hepatomegaly, and lactic acidosis. Computed tomography revealed swollen liver parenchyma with a diffusely high absorption. The patient gradually recovered without any medical intervention except for adequate control of blood sugar and was moved to a psychiatric ward on day 8 for schizophrenia management. This report may help emergency physicians be aware of the common symptoms, clinical course, and pathophysiology of glycogenic hepatopathy. Doctors should include glycogenic hepatopathy in the differential diagnosis of abnormal liver enzymes and hepatomegaly for those with poorly controlled insulin-dependent diabetes mellitus or unstable blood sugar levels due to insulin overdose like our patient.
胰岛素依赖型1型或2型糖尿病控制不佳的患者很少出现糖原性肝病，其特征为肝肿大和肝酶异常。糖原性肝病是胰岛素导致肝细胞内糖原过度蓄积的结果。我们报告1例1型糖尿病年轻男性患者，其在通过皮下注射过量胰岛素自杀未遂后发生了糖原性肝病。由于合并精神分裂症，该患者的药物/营养依从性及胰岛素治疗依从性较差。因长效胰岛素过量导致持续性难治性低血糖，我们的患者需要大量持续葡萄糖输注以维持血糖正常。入院第4天，患者出现转氨酶升高、肝肿大及乳酸酸中毒。计算机断层扫描显示肝实质肿胀，呈弥漫性高吸收。除血糖得到充分控制外，患者未经任何医学干预逐渐康复，并于第8天转至精神科病房治疗精神分裂症。本报告可能有助于急诊医生了解糖原性肝病的常见症状、临床过程及病理生理学。对于像我们的患者这样胰岛素依赖型糖尿病控制不佳或因胰岛素过量导致血糖不稳定的患者，医生应将糖原性肝病纳入肝酶异常和肝肿大的鉴别诊断中。
