Prolonged Coma after Single, Unintentional Overdose of Insulin: Concurring Factors Leading to a Persistent Neurological Condition

Luljeta Çakërri¹, Elira Myrtaj², Gentian Vyshka^1, and Florian Toti²

¹Biomedical and Experimental Department, Faculty of Medicine, University of Medicine in Tirana, Albania

²Service of Endocrinology, University Hospital Center “Mother Theresa”, Tirana, Albania

Cite this paper

Luljeta Çakërri, Elira Myrtaj, Gentian Vyshka and Florian Toti. Prolonged Coma after Single, Unintentional Overdose of Insulin: Concurring Factors Leading to a Persistent Neurological Condition. American Journal of Medical Case Reports. 2014; 2(2):41-43. doi: 10.12691/AJMCR-2-2-4

Abstract

We refer the case of a 62-year old female diabetic patient, under insulin therapy since twelve year. She was found unconscious from her husband and the emergency team assisting the patient on site found a newly opened insulin vial of 10 ml half empty. Supposedly she had injected almost five ml of insulin glargine, with a total of 500 UI of insulin, and the plasma glucose value of 29 mg/dl supported the overdose diagnosis. The patient was emergently admitted in an intensive care unit with profound hypoglycemia and hypokalemia, and in deep coma. Dextrose bolus and continuous infusions normalized her glycemic levels only after three days of uninterrupted perfusions, with the patient remaining in coma for another two days after glycemia normalization. Discharged with a paraparetic gait as neurological sequelae, she improved considerably within the next month from the event. The reason of overdose was not clearly formulated, but a tricyclic antidepressant was added on in the therapy after psychiatric consultancy was obtained.

Keywords

insulin overdose, hypoglycemia, hypokalemia

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

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