Hypoglycemic Encephalopathy Caused by Insulin Aspart (Novorapid ®) Overdose During a Suicide Attempt

Makoto Onodera, Yasuhisa Fujino, Yoshihiro Inoue, Tatsuyori Shozushima, Satoshi Kikuchi, Shigeatsu Endo

Abstract


    We present a case of a 41-year-old man who attempted suicide by injection of 600 units of insulin aspart. On arrival at the ER (after eating high-carbohydrate foods), he was awake and blood glucose was 40 mg/dl. He received a total glucose load of 230 g in the first 15 hours. Head CT was not remarkable. He was discharged on day 14. Three weeks later, he was found in a deep coma. He had injected 900 units of insulin aspart in a suicide attempt 8 hours prior to be found. On arrival, he was comatose and his blood glucose was 19 mg/dl. Head CT revealed low density areas throughout the cerebral cortex and partial cerebral edema. He received a total glucose load of 270 g in the first 22 hours. A repeat head CT examination on day 9, revealed worsening of the findings throughout the cerebral cortex. He fell into an apallic syndrome and was transferred to a local hospital. In the second overdose, the patient rapidly developed a sustained hypoglycemia, and fell into hypoglycemic encephalopathy because of the delay in receiving appropriate treatment. We consider that insulin aspart overdose may, in fact, predispose to hypoglycemic encephalopathy compared with long-acting insulin. 




doi:10.4021/jmc574w

Keywords


Rapid-acting insulin; Acute poisoning; Diabetes Mellitus

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