Acute hepatic steatosis complicating massive insulin overdose and excessive glucose administration.
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.


METHODS
Case report, clinical.


METHODS
Intensive care unit, university hospital.


METHODS
A single patient admitted to the ICU.


METHODS
Intravenous glucose after insulin overdose.


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.
Medical ICU Division, University Hospital, Geneva, Switzerland. jolliet@cmu.unige.ch
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D000140:Acidosis, Lactic / Q000209:etiology* / Q000628:therapy; D004040:Dietary Carbohydrates / Q000009:adverse effects*; D005234:Fatty Liver / Q000209:etiology* / Q000628:therapy; D005260:Female; D006801:Humans; D007328:Insulin / Q000506:poisoning*; D008875:Middle Aged
D004040:Dietary Carbohydrates; D007328:Insulin