Insulin overdose

Insulin overdose Miscellaneous Aminoglycosides Amphotericin B Cisplatin ... 

Hoffbrand BI, Sevitt LH. Use of mannitol in prolonged coma due to insulin overdose. Lancet 1966 1(7434) 402. 

Severe hypoglycemia caused by hyperinsulinism may occur in cases of insulin overdose, when food intake is decreased or delayed, during periods of excessive exercise, or in patients with brittle diabetes. 

Severe hypoglycemia caused by hyperinsulinism may occur with insulin overdose, decrease or delay of food intake, or excessive exercise and in those with brittle diabetes. 

Pulmonary edema secondary to hypoglycemia was reported particularly in the 1930s when insulin shock treatment was used for schizophrenia. It is less common nowadays, but has been reported after insulin overdose (16). 

Insulin overdose has been reported in patients without diabetes (282) and in a 25-year-old man with Munchausen s syndrome (283). 

Hypokalemia, hypophosphatemia, and hypomagnesemia can occur after insulin overdose (285). 

Acute liver damage has been attributed to insulin overdose followed by excessive glucose administration (99). 

Acute steatosis of the liver may have explained this presentation. In insulin overdose, the combination of greatly increased hepatic production of triglycerides from glucose and reduced production of apolipoprotein B 100 results in an insufficient increase in the transport of triglycerides in VLDL particles from liver to muscle and adipose tissue and contributes to the steatosis. 

Uchida D, Ohigashi S, Hikita S, Kitamura N, Motoyoshi M, Tatasuno I. Acute pulmonary edema caused by hypo-glycaemia due to insulin overdose. Int Med 2004 43 1056-9. 

Arem R, Zoghbi W. Insulin overdose in eight patients insulin pharmacokinetics and review of the literature. Medicine (Baltimore) 1985 64(5) 323-32. 

Jolliet P, Leverve X, Pichard C. Acute hepatic steatosis complicating massive insulin overdose and excessive glucose administration. Intensive Care Med 2001 27(l) 313-6. 

Winston DC. Suicide via insulin overdose in nondiabetics the New Mexico experience. Am J Forensic Med Pathol 2000 21(3) 237-40. 

Matsumura M, Nakashima A, Tofuku Y. Electrolyte disorders following massive insulin overdose in a patient with type 2 diabetes. Intern Med 2000 39(l) 55-7. 

B. The most serious consequence of insulin overdose is hypoglycemia. 

Q14 The presence of hypoglycaemia should be considered in any unconscious patient. If an insulin overdose is suspected, 10-20 g glucose is given by mouth to conscious patients, for example as sugar lumps. In unconscious patients a 50 ml bolus of 50% glucose solution can be administered intravenously, or 1 mg glucagon administered subcutaneously, intramuscularly or intravenously. 

If tile route of administration is suspected to be intrmiuscular injection, e.g. in insulin overdose, a 10-cm cube of muscle from the injection site should be taken as well as a control sample of the same size from a similar but uninjected part of the body. Smaller smiples should be tdcen if the injection site is nearer tiie surface, e.g. as in subcutaneous injections. 

Insulin overdose Medium High High Unacceptable... 

Hypoglycemia Abrupt withdrawal of dextrose, insulin overdose Increase dextrose intake decrease exogenous insulin taper infusion rate prior to discontinuing PN... 

Beta-receptor antagonists mask the symptoms of hypoglycemia (e.g., tachycardia, diaphoresis). and thus mask the symptoms of insulin overdose. This could lead to insulin shock. 

Hypoglycaemia caused by insulin overdose or inadequate calorific intake is the most common and most serious complication of insulin... 

There have been a number of incidences where insulin overdose has resulted in severe hypoglycaemia in humans. Although this can occur accidentally, it is frequently the result of a suicide attempt. As insulin is conveniently at hand to both diabetics and their physicians, it has been used by both groups to attempt suicide. However, overdose is not always intentional and suicide attempts using insulin are not always by affected patients. Moreover, abuse of insulin, especially by adolescents, may play a part in some overdoses. ... 

T. A. Mork, C. T. Killeen, N. K. Patel, J. M. Dohnal, H. C. Karydes and J. B. Leikin, Massive insulin overdose managed by monitoring daily insulin levels. Am. J. Ther., 2011, 18, el62-el66. 

K. S. Russell, J. R. Stevens and T. A. Stern, Insulin overdose among patients with diabetes a readily available means of suicide. Prim. Care Companion J. Clin. Psychiatry, 2009, 11, 258-262. 

F. I. Martin, N. Hansen and G. L. Warne, Attempted suicide by insulin overdose in insulin-requiring diabetics, Med. J. Aust., 1977, 1, 58 0. 

Y. Shibutani and C. Ogawa, Suicidal insulin overdose in a type 1 diabetic patient relation of serum insulin concentrations to the duration of hypoglycaemia, J. Diabetes Complications, 2000, 14, 60-62. 

D. Uchida, S. Ohigashi, S. Hikita, N. Kitamura, M. Motoyoshi and I. Tatsuno, Acute pulmonary edema caused by hypoglycaemia due to insulin overdose. Intern. Med., 2004, 43, 1056-1059. 

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