Acute hepatic steatosis complicating massive insulin overdose and excessive glucose administration.
Détails
ID Serval
serval:BIB_34D37FCE1700
Type
Article: article d'un périodique ou d'un magazine.
Sous-type
Etude de cas (case report): rapporte une observation et la commente brièvement.
Collection
Publications
Institution
Titre
Acute hepatic steatosis complicating massive insulin overdose and excessive glucose administration.
Périodique
Intensive Care Medicine
ISSN
0342-4642 (Print)
ISSN-L
0342-4642
Statut éditorial
Publié
Date de publication
2001
Peer-reviewed
Oui
Volume
27
Numéro
1
Pages
313-316
Langue
anglais
Notes
Publication types: Case Reports ; Journal ArticlePublication Status: ppublish
Résumé
OBJECTIVE: To describe a case of acute hepatic steatosis due to excessive administration of glucose in the setting of massive insulin overdose, a complication which is rapidly and completely reversible if glucose infusion is rapidly tapered.
DESIGN: Case report, clinical.
SETTING: Intensive care unit, university hospital.
PATIENT: A single patient admitted to the ICU.
INTERVENTION: Intravenous glucose after insulin overdose.
MEASUREMENTS AND MAIN RESULTS: On the 3rd day, increases in transaminase (ASAT 420 IU/l, ALAT 610 IU/l), bilirubin (147 mmol/l) and lactate (6.8 mmol/l), a decrease in arterial pH (7.32) and slightly increased liver size on ultrasound examination suggested acute hepatic steatosis. Clinical and laboratory abnormalities resolved rapidly after discontinuation of excessive glucose infusions (1,400 g/day for 3 days).
CONCLUSIONS: Very large amounts of glucose after massive insulin overdose are potentially dangerous. Even though the fear of hypoglycemia-induced neurologic damage should be a constant preoccupation in this situation, glucose administration should be titrated on closely monitored blood glucose levels.
DESIGN: Case report, clinical.
SETTING: Intensive care unit, university hospital.
PATIENT: A single patient admitted to the ICU.
INTERVENTION: Intravenous glucose after insulin overdose.
MEASUREMENTS AND MAIN RESULTS: On the 3rd day, increases in transaminase (ASAT 420 IU/l, ALAT 610 IU/l), bilirubin (147 mmol/l) and lactate (6.8 mmol/l), a decrease in arterial pH (7.32) and slightly increased liver size on ultrasound examination suggested acute hepatic steatosis. Clinical and laboratory abnormalities resolved rapidly after discontinuation of excessive glucose infusions (1,400 g/day for 3 days).
CONCLUSIONS: Very large amounts of glucose after massive insulin overdose are potentially dangerous. Even though the fear of hypoglycemia-induced neurologic damage should be a constant preoccupation in this situation, glucose administration should be titrated on closely monitored blood glucose levels.
Mots-clé
Acidosis, Lactic/etiology, Acidosis, Lactic/therapy, Dietary Carbohydrates/adverse effects, Fatty Liver/etiology, Fatty Liver/therapy, Female, Humans, Insulin/poisoning, Middle Aged
Pubmed
Web of science
Création de la notice
27/06/2013 15:54
Dernière modification de la notice
20/08/2019 14:21