دورية أكاديمية
Successful management of severe diabetic ketoacidosis in a patient with type 2 diabetes with insulin allergy: a case report.
| العنوان: | Successful management of severe diabetic ketoacidosis in a patient with type 2 diabetes with insulin allergy: a case report. |
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| المؤلفون: | Nguyen AD; Department of Emergency and Critical Care Medicine, Hanoi Medical University, 01 Ton That Tung street, Kim Lien ward, Dong Da district, Hanoi, Vietnam.; Emergency Department, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, Vietnam., Luong CQ; Department of Emergency and Critical Care Medicine, Hanoi Medical University, 01 Ton That Tung street, Kim Lien ward, Dong Da district, Hanoi, Vietnam. luongquocchinh@hotmail.com.; Emergency Department, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, Vietnam., Chu HC; Allerology and Clinical Immunology Center, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, Vietnam.; Department of Allergy and Clinical Immunology, Hanoi Medical University, 01 Ton That Tung street, Kim Lien ward, Dong Da district, Hanoi, Vietnam., Nguyen VKD; Endocrinology and Diabetes Department, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, Vietnam.; Department of Internal Medicine, Hanoi Medical University, Hanoi, Vietnam, 01 Ton That Tung street, Kim Lien ward, Dong Da district, Hanoi, Vietnam., Nguyen CV; Department of Emergency and Critical Care Medicine, Hanoi Medical University, 01 Ton That Tung street, Kim Lien ward, Dong Da district, Hanoi, Vietnam.; Emergency Department, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, Vietnam., Nguyen TA; Department of Emergency and Critical Care Medicine, Hanoi Medical University, 01 Ton That Tung street, Kim Lien ward, Dong Da district, Hanoi, Vietnam. bsnguyenanhtuan@yahoo.com.vn.; Emergency Department Department, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, Vietnam. bsnguyenanhtuan@yahoo.com.vn., Nguyen QH; Department of Emergency and Critical Care Medicine, Hanoi Medical University, 01 Ton That Tung street, Kim Lien ward, Dong Da district, Hanoi, Vietnam.; Emergency Department, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, Vietnam., Mai TD; Department of Emergency and Critical Care Medicine, Hanoi Medical University, 01 Ton That Tung street, Kim Lien ward, Dong Da district, Hanoi, Vietnam.; Emergency Department, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, Vietnam., Nguyen DV; Allerology and Clinical Immunology Center, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, Vietnam.; Department of Allergy and Clinical Immunology, Hanoi Medical University, 01 Ton That Tung street, Kim Lien ward, Dong Da district, Hanoi, Vietnam., Nguyen BQ; Endocrinology and Diabetes Department, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, Vietnam.; Department of Internal Medicine, Hanoi Medical University, Hanoi, Vietnam, 01 Ton That Tung street, Kim Lien ward, Dong Da district, Hanoi, Vietnam., Tran TH; Department of Emergency and Critical Care Medicine, Hanoi Medical University, 01 Ton That Tung street, Kim Lien ward, Dong Da district, Hanoi, Vietnam.; Emergency Department, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, Vietnam., Dao PV; Department of Emergency and Critical Care Medicine, Hanoi Medical University, 01 Ton That Tung street, Kim Lien ward, Dong Da district, Hanoi, Vietnam.; Emergency Department, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, Vietnam., Nguyen DT; Department of Emergency and Critical Care Medicine, Hanoi Medical University, 01 Ton That Tung street, Kim Lien ward, Dong Da district, Hanoi, Vietnam.; Emergency Department, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, Vietnam., Nguyen NN; Allerology and Clinical Immunology Center, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, Vietnam.; Department of Allergy and Clinical Immunology, Hanoi Medical University, 01 Ton That Tung street, Kim Lien ward, Dong Da district, Hanoi, Vietnam., Do SN; Department of Emergency and Critical Care Medicine, Hanoi Medical University, 01 Ton That Tung street, Kim Lien ward, Dong Da district, Hanoi, Vietnam. sonngocdo@gmail.com.; Emergency Department, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, Vietnam. sonngocdo@gmail.com. |
| المصدر: | BMC endocrine disorders [BMC Endocr Disord] 2019 Nov 11; Vol. 19 (1), pp. 121. Date of Electronic Publication: 2019 Nov 11. |
| نوع المنشور: | Case Reports; Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: BioMed Central Country of Publication: England NLM ID: 101088676 Publication Model: Electronic Cited Medium: Internet ISSN: 1472-6823 (Electronic) Linking ISSN: 14726823 NLM ISO Abbreviation: BMC Endocr Disord Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: London : BioMed Central, [2001- |
| مواضيع طبية MeSH: | Diabetes Mellitus, Type 2/*complications , Diabetic Ketoacidosis/*drug therapy , Drug Hypersensitivity/*prevention & control , Infusions, Intravenous/*methods , Insulin/*administration & dosage, Diabetic Ketoacidosis/etiology ; Drug Hypersensitivity/etiology ; Humans ; Insulin/adverse effects ; Insulin Infusion Systems ; Male ; Middle Aged ; Prognosis |
| مستخلص: | Background: Diabetic ketoacidosis (DKA) is an acute, major, life-threatening complication of diabetes that requires immediate treatment. Allergic reaction to insulin is rare, especially when using recombinant human insulin. The clinical presentation of insulin allergy can range from minor local symptoms to a severe generalized allergic reaction such as anaphylaxis. A limited number of cases have been reported on the treatment of severe DKA in patients with type 2 diabetes with insulin allergy. Here, we describe a patient with type 2 diabetes with insulin allergy in which severe DKA resolved after the initiation of continuous intravenous (IV) recombinant human insulin infusion. Case Presentation: A 58-year-old man with type 2 diabetes initiated subcutaneous insulin administration (SIA) after failure of oral antidiabetic treatment. Symptoms of an allergic reaction developed, including pruritic wheals appearing within 10 min of injection and lasting over 24 h. Both skin prick and intradermal tests were positive with different types of insulin. Two days before admission, he stopped SIA because of allergic symptoms and then experienced weakness and upper abdominal pain. On admission, he was in severe metabolic acidosis with a pH of 6.984 and bicarbonate of 2.5 mmol/litre. The blood glucose level was 20.79 mmol/litre, BUN 4.01 mmol/litre, creatinine 128 μmol/litre, and urinary ketone 11.44 mmol/litre. Over 24 h, metabolic acidosis was refractory to IV fluids, bicarbonate and potassium replacement, as well as haemodialysis. Ultimately, he received continuous IV recombinant human insulin infusion at a rate of 0.1 units/kg/hour, in combination with haemodiafiltration, and no further allergic reactions were observed. On day 5, ketonaemia and metabolic acidosis completely resolved. He had transitioned from IV insulin infusion to SIA on day 14. He was discharged on day 21 with SIA treatment. Three months later, he had good glycaemic control but still had allergic symptoms at the insulin injection sites. Conclusions: In this patient, SIA caused an allergic reaction, in contrast to continuous IV insulin infusion for which allergic symptoms did not appear. Continuous IV recombinant human insulin infusion in combination with haemodiafiltration could be an option for the treatment of severe DKA in patients with diabetes with insulin allergy. |
| References: | Conn Med. 2011 Aug;75(7):405-7. (PMID: 21905534) J Pharm Sci. 1997 May;86(5):517-25. (PMID: 9145374) Diabetologia. 2016 Oct;59(10):2082-7. (PMID: 27397023) J Clin Invest. 1986 Mar;77(3):717-23. (PMID: 3512601) Diabetes Care. 1993 Dec;16 Suppl 3:155-65. (PMID: 8299472) Allergy. 2008 Feb;63(2):148-55. (PMID: 18186805) Med Clin North Am. 1995 Jan;79(1):9-37. (PMID: 7808097) BMJ. 2013 Jun 10;346:f3501. (PMID: 23751904) Endocr Rev. 2007 Oct;28(6):625-52. (PMID: 17785428) J Med Case Rep. 2008 Aug 26;2:283. (PMID: 18727824) N Engl J Med. 2015 Feb 5;372(6):546-54. (PMID: 25651248) Diabetes Metab. 2005 Sep;31(4 Pt 1):391-400. (PMID: 16369203) Vet Clin North Am Small Anim Pract. 2017 Mar;47(2):205-207. (PMID: 28017408) Med Sci Monit. 2016 Feb 02;22:346-55. (PMID: 26831818) Diabetes Res Clin Pract. 2012 Aug;97(2):e31-3. (PMID: 22609054) J Anesth. 2006;20(2):129-31. (PMID: 16633773) Diabetes Care. 1982 Nov-Dec;5 Suppl 2:126-8. (PMID: 6765522) J Clin Invest. 1956 Feb;35(2):170-90. (PMID: 13286336) N Engl J Med. 2006 Jan 19;354(3):307-9. (PMID: 16421379) Diabetes Care. 2009 Jul;32(7):1335-43. (PMID: 19564476) J Allergy Clin Immunol. 2012 Mar;129(3):748-52. (PMID: 22051698) |
| فهرسة مساهمة: | Keywords: Continuous intravenous insulin infusion; Diabetic ketoacidosis; Insulin allergy; Recombinant human insulin; Type 2 diabetes |
| المشرفين على المادة: | 0 (Insulin) |
| تواريخ الأحداث: | Date Created: 20191113 Date Completed: 20200414 Latest Revision: 20200414 |
| رمز التحديث: | 20231215 |
| مُعرف محوري في PubMed: | PMC6849168 |
| DOI: | 10.1186/s12902-019-0451-7 |
| PMID: | 31711488 |
| قاعدة البيانات: | MEDLINE |
Find this article in full text from Springer Verlag. 
Full Text Finder | تدمد: | 1472-6823 |
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| DOI: | 10.1186/s12902-019-0451-7 |