Intentional overdose with insulin: prognostic factors and toxicokinetic/toxicodynamic profiles

Mégarbane, Bruno; Deye, Nicolas; Bloch, Vanessa; Sonneville, Romain; Collet, Corinne; Launay, Jean‐Marie; Baud, Frédéric J.

doi:10.1186/cc6168

Cited by 46 publications

(42 citation statements)

References 36 publications

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“…In addition, in most cases the time between overdose and admission was reported to be less than 10 h (Table 1). Megarbane et al have reported that a delay of therapy in excess of 6 h was associated with poor outcomes [14]. Since our cases in which the time of injection was not available had all recovered with no sequela, it is suggested that the delay in therapy in these cases was relatively short, not greatly changing our conclusion.…”

Section: Acknowledgementsmentioning

confidence: 50%

Prediction of recovery time from hypoglycemia in patients with insulin overdose

et al. 2011

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UnfortUnately suicidal insulin overdose often occurs in patients with mental illness [1]. Insulin overdose results in prolonged hypoglycemia. Since there is no appropriate marker to estimate the recovery time from hypoglycemia, prolonged hypoglycemia often persists after stopping glucose supplementation. Here we hypothesized that if a huge amount of insulin is injected, the duration of hypoglycemia depends on the dose of insulin rather than the type of insulin, and provide an equation for the correlation between insulin dose and recovery time from hypoglycemia. research Design and MethodsWe conducted a literature review of Japanese cases of insulin overdose using PubMed and Ichushi web (Japana Centra Revuo Medicina). We identified 43 cases of insulin overdose. Among them, we excluded 9 cases in which the injected insulin dose and/or recovery time from hypoglycemia was not available. We also excluded 2 cases that had been receiving hemodi- abstract. Insulin overdose results in prolonged hypoglycemia. We hypothesized that if a huge amount of insulin is subcutaneously injected, the duration of hypoglycemia depends on the dose of insulin rather than the type of insulin. We conducted a literature review of insulin overdose and 33 cases were included in this study. We assessed the correlation between recovery time from hypoglycemia and insulin dose. As a result, there was a significant correlation between recovery time from hypoglycemia and insulin dose (r = 0.88, p <0.0001) and this correlation was expressed as y = 0.045x; where y is time (h) and x is insulin dose (U), corresponding to that if 1000 U insulin is injected, hypoglycemia will persist for ~45 h. This equation may be useful to predict the duration of glucose supplementation for treatment of insulin overdose.

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Section: Acknowledgementsmentioning

confidence: 50%

Prediction of recovery time from hypoglycemia in patients with insulin overdose

et al. 2011

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“…46 in total, presented with coma and had poor outcome of death [5,7,11,15,17,24,27,34,36,43], persistent vegetative state [2,3,12,13,16,19,20,39,42], or limited recovery with severe long-term neurological deficits [9,22,23,26,42]. Where recorded, glucose levels at presentation ranged from 10 mg/dl to 60 mg/dl (mean 24 mg/dl), and duration of hypoglycaemia was greater than 6 hours in all but two cases [24,34].…”

Section: Resultsmentioning

confidence: 99%

Acute symptomatic hypoglycaemia mimicking ischaemic stroke on imaging: a systemic review

et al. 2012

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BackgroundAcute symptomatic hypoglycaemia is a differential diagnosis in patients presenting with stroke-like neurological impairment, but few textbooks describe the full brain imaging appearances. We systematically reviewed the literature to identify how often hypoglycaemia may mimic ischaemic stroke on imaging, common patterns and relationships with hypoglycaemia severity, duration, clinical outcome and add two new cases.MethodsWe searched EMBASE and Medline databases for papers reporting imaging in adults with symptomatic hypoglycaemia. We analysed the clinical presentation, outcome, brain imaging findings, duration and severity of hypoglycaemia, time course of lesion appearance, including two new cases.ResultsWe found 42 papers describing computed tomography or magnetic resonance imaging in 65 patients, plus our two cases with symptomatic hypoglycaemia. Imaging abnormalities on computed tomography and magnetic resonance were uni or bilateral, cortical or sub-cortical. Thirteen (20%) mimicked cortical or lacunar stroke. Acute lesions had restricted diffusion on magnetic resonance or low attenuation on computed tomography, plus swelling; older lesions showed focal atrophy or disappeared, as with ischaemic stroke. The association between the depth or duration of hypoglycaemia, the severity or extent of neurological deficit, and the imaging abnormalities, was weak.ConclusionImaging abnormalities in patients with hypoglycaemia are uncommon but very variable, weakly associated with neurological deficit, and about a fifth mimic acute ischaemic stroke. Blood glucose testing should be routine in all patients with acute neurological impairment and hypoglycaemia should be included in the differential diagnosis of imaging appearances in patients presenting with acute stroke.

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“…In cases of acute poisoning, insulin levels reflect delays of insulin activity, including delayed absorption from the injection site and possibly prolonged clearance of absorbed insulin. In insulin (self)-overdose exogenous insulin follows first-order kinetics, resulting in a linear decrease in concentrations using a semi-logarithmic scale [22]. Using non-compartmental analysis in a case of human insulin intoxication in a type 1 diabetic, Shibutani and Ogawa [23] found an elimination half-life of 6.2 h. In another case of insulin poisoning in a type 1 diabetic patient, Fasching [24] identified a slow biphasic decrease with half-lives of 4 and 10 h for the two successive phases, respectively.…”

Section: Human Insulin Synthetic Insulin Analogues C-peptide and Prmentioning

confidence: 99%

Disorders of glucose metabolism: post mortem analyses in forensic cases–part II

2010

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In continuation to part I, a literature review is presented concerning biochemical problems of forensic post mortem cases of unclear hyperglycaemia or hypoglycaemia. Clinical parameters for this purpose were recently reviewed. Particular attention was paid to the detection of diabetic ketoacidosis, of hyperosmolar coma, insulinoma, insulin-induced or oral diabetic-induced hypoglycaemia. The second part of the review discusses the analytes ketone bodies, synthetic insulins, human insulin, C-peptide, proinsulin and insulin antibodies. Special interest is given to post mortem matrices for those analytes to reference concentrations, stability data, analytic interferences and analytical procedures which should be used in toxicological laboratories willing to detect diabetic metabolism disorders after death.

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Intentional overdose with insulin: prognostic factors and toxicokinetic/toxicodynamic profiles

Abstract: Introduction Prognostic factors in intentional insulin selfpoisoning and the significance of plasma insulin levels are unclear. We therefore conducted this study to investigate prognostic factors in insulin poisoning, in relation to the value of plasma insulin concentration.

Cited by 46 publications

References 36 publications

Prediction of recovery time from hypoglycemia in patients with insulin overdose

Prediction of recovery time from hypoglycemia in patients with insulin overdose

Acute symptomatic hypoglycaemia mimicking ischaemic stroke on imaging: a systemic review

Disorders of glucose metabolism: post mortem analyses in forensic cases–part II

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