Roberge R J, Martin T G, Delbridge T R
Toxicology Treatment Program, University of Pittsburgh Medical Center, Pennsylvania.
Ann Emerg Med. 1993 Feb;22(2):228-34. doi: 10.1016/s0196-0644(05)80210-0.
A case of intentional massive insulin overdose requiring prolonged glycemic support is presented. Suicidal insulin overdose may be more common than generally appreciated. Because hypoglycemic reactions are evaluated routinely in the ED, emergency physicians should maintain a high degree of suspicion regarding suicidal intent or foul play in diabetics with hypoglycemia who respond minimally to the administration of concentrated glucose solutions or in hypoglycemic presentations by nondiabetics who have access to diabetic medications. Fingerstick glucose evaluations or serum glucose levels should be obtained routinely at 15 to 30 minutes after glucose administration in any hypoglycemic patient to gauge the intensity of glucose use. Inability to maintain euglycemia following glucose administration suggests excessive insulin and requires further workup. Evaluation of serum insulin and C-peptide levels is useful in confirming intentional overdoses in cases that are not clear-cut. Glucose infusion rates must be tailored individually to each overdose situation as great individual variability exists in insulin absorption and effects. The clinician should anticipate the possible need for prolonged glycemic support in this setting.
本文介绍了一例因故意大量过量使用胰岛素而需要长期血糖支持的病例。自杀性胰岛素过量使用可能比普遍认为的更为常见。由于急诊科会常规评估低血糖反应，对于那些对高渗葡萄糖溶液治疗反应甚微的糖尿病低血糖患者，或有机会接触糖尿病药物的非糖尿病患者出现低血糖症状时，急诊医生应高度怀疑其有自杀意图或存在不当行为。对于任何低血糖患者，在给予葡萄糖后15至30分钟应常规进行指尖血糖评估或检测血清葡萄糖水平，以评估葡萄糖的利用强度。给予葡萄糖后无法维持血糖正常提示胰岛素过量，需要进一步检查。在情况不明确的病例中，评估血清胰岛素和C肽水平有助于确诊故意过量用药。由于胰岛素吸收和作用存在很大的个体差异，葡萄糖输注速率必须根据每个过量用药情况进行个体化调整。临床医生应预料到在这种情况下可能需要长期的血糖支持。
