The No-Sugar Daddy

A 40-year-old man presented with hypoglycemia following an intentional overdose with Humalog Mix 75/25 (75% insulin lispro protamine suspension and 25% insulin lispro injection). He reported injecting 900 units into his abdomen one hour prior to ED presentation. He complained of lightheadedness and nausea. His initial vital signs were heart rate 110 bpm, blood pressure 112/70 mm Hg, respiratory rate 14 breaths per minute, and oxygen saturation 99% on room air. His physical exam is remarkable for a visible injection site on the abdomen. Blood glucose is 50, potassium is 3.1, and creatinine is 0.8. The patient reports a prescribed dose of Humalog 75/25 20 units SQ before breakfast and again before dinner. (Table 1.)     The adverse effects of insulin overdose result from hypoglycemia, and include diaphoresis, tachycardia, anxiety, hunger, impaired cognition, agitation, and hypothermia. Severe or protracted cases may result in seizure, coma, permanent neurologic damage, and death. Hypokalemia may also occur because of insulin’s effect on the intracellular shifting of potassium.   These diagnostic tests should be considered in an insulin overdose: n Blood glucose levels (bedside or laboratory) n Insulin level and C-peptide       - Insulin is endogenously secreted as proinsulin, which is cleaved to form insulin and C-peptide. A decreased or nonexistent level of C-peptide is an indicator of surreptitious insulin administration.             n Potassi...
Source: The Tox Cave - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs