title: Unintentional use of mistaken insulin products: a retrospective review of poison center data.
abstract: BACKGROUND
  There are no guidelines for the management of accidental insulin administration. We hypothesized that home monitoring of asymptomatic patients (pts) was safe following unintentionally insulin administration.
  
  
  METHODS
  Retrospective review of poison center (PCC) charts from 1/1/2000-12/31/2010 looking for accidental insulin administrations.
  
  
  METHODS
  pt must be prescribed insulin. Information recorded from charts: pt age/gender, "intended" and "mistaken" insulin formulations/doses, use of oral diabetic agents, management site, Emergency Department (ED) referral, symptoms, blood glucose values, and treatments. Defined outcomes: symptoms (e.g., altered sensorium); hypoglycemia (<60 mg/dL); management site; health care facility (HCF) admission; and death. Multiple logistic regression was used to determine outcome predictors.
  
  
  RESULTS
  652 charts met inclusion criteria. Mean age was 56.4 years; most (58.5%) were women. Most (89%) calls originated from home, 10.7% from a HCF, 0.3% from Emergency Medical Services (EMS). Overall, 397 (60.9%) pts were managed at home. Two pts managed at home were later evaluated by EMS; neither required admission. Symptoms developed in 56 (8.6%) pts. There were no deaths. Only 40 (6.1%) pts were admitted to a HCF; 18 (45%) pts were hypoglycemic. The development of hypoglycemia (odds ratio [OR] 5.94; p < 0.001) and amount of insulin accidentally administered (OR 1.04; p < 0.001) predicted HCF referral. The type and dose of insulin administered did not predict symptoms.
  
  
  CONCLUSIONS
  Based on a retrospective analysis of a single PCC's cases, home observation of asymptomatic patients after unintentional administration of a wrong insulin formulation appears safe.
authors.affiliation: Banner Good Samaritan Poison Control and Drug Information Center, Phoenix, Arizona.
authors.forename: Diane
authors.initials: D
authors.lastname: Glogan
authors.forename: Rachel D
authors.initials: RD
authors.lastname: Levitan
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Brooks
authors.forename: Richard D
authors.initials: RD
authors.lastname: Gerkin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D062787:Drug Overdose / Q000628:therapy*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced; D007328:Insulin / Q000008:administration & dosage / Q000506:poisoning*; D008297:Male; D008508:Medication Errors; D008875:Middle Aged; D011039:Poison Control Centers / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D057832:Watchful Waiting; D055815:Young Adult
chemical_list: D007328:Insulin
keywords: insulin toxicity; poison center utilization; unintentional poisoning