Insulin glargine overdose
A 76-year-old male presented to our Emergency Department (ED) after an intentional overdose of insulin glargine (LANTUS®). He was found by his friend diaphoretic and anxious, but responsive. He reported that he attempted to suicide by injecting himself 500 units insulin glargine subcutaneously. There was no information about blood glucose level at the time of ambulance arrival.\nOn initial ED evaluation, he was conscious, Glasgow Coma Score was 15/15; and vital signs were as follows: Blood pressure 120/70 mmHg, pulse rate 98 bpm, body temperature 36 °C; and respiratory rate 18 pm. Diaphoresis was still continuing and physical examination revealed nothing pathological but tachycardia.\nFinger-stick glucose was 30 mg/dl (Reference range: 70-106 mg/dl). Simultaneous chemistry revealed 41 mg/dl. He was started 50 cc 50 % dextrose IV and continued on 10 % dextrose at 50 cc/h. Over the next 96 h he received a 10 % dextrose infusion at 50 cc/h and he was needed to administer extra glucose boluses for several times because of hypoglycemia periods [].\nSerum potassium level was 3.11 meq/l (Reference range: 3.5 – 5.2 meq/l). Other parameters such as sodium, phosphate, calcium and liver function tests were in the normal range. Oral potassium chloride was started since serum level was found as low as 3.17 meq/l. Oral potassium chloride was arranged as needed during follow up period.\nIn his past medical history, he emphasized insulin-dependent diabetes for 25 years, hypertension, parkinson disease, panic disorder; and dementia. Current medications included insulin glargine 14 units twice daily, Losartan plus, levodopa+carbidopa+entacapone and piracetam.\nAfter 96 h, he was transferred to Internal Medicine ward for close monitoring; then consulted to psychiatry and endocrinology.\nAt the fifth day of follow up, hypoglycemia periods were terminated and he was discharged on appointed outpatient clinic.