title: Peripheral IV Insulin Infusion Infiltration Presenting as "Insulin Resistance".
abstract: OBJECTIVE
  We present the case of a 66-year-old woman who developed hypoglycemia following the prolonged infiltration of a high dose continuous peripheral IV insulin infusion.
  
  
  METHODS
  Case report.
  
  
  METHODS
  PubMed was searched for relevant literature on exogenous hyperinsulinemic hypoglycemia.
  
  
  RESULTS
  The patient was postlung transplantation and was receiving high doses of glucocorticoids. Despite increasing the peripheral IV insulin rate, hyperglycemia persisted. We discovered that the IV insulin infusion line infiltrated, resulting in a large subcutaneous insulin depot, estimated to be 450 units of regular insulin. She subsequently experienced prolonged hypoglycemia that was managed with concentrated dextrose containing fluids. In our literature search, there were no similar case reports. The literature on insulin overdose, usually from suicide attempts, can help guide the management of iatrogenic hyperinsulinemic hypoglycemia. Important management considerations include anticipated duration of hypoglycemia, supplemental glucose, fluid management, and electrolyte monitoring.
  
  
  CONCLUSIONS
  Peripheral IV insulin infusion infiltration should be considered when patients do not respond to increasing rates of insulin infusion.
authors: 1Department of Medicine, University of California, San Francisco, CA. 2Departments of Pharmacy and Nursing, University of California, San Francisco, CA.
authors: Tiffany Y
authors: TY
authors: Kim
authors: Kenneth A
authors: KA
authors: Woeber
authors: Heidimarie Windham
authors: HW
authors: MacMaster
authors: Robert J
authors: RJ
authors: Rushakoff
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced*; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D008508:Medication Errors
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin; C018503:insulin, depot-