Intentional overdose with insulin: prognostic factors and toxicokinetic/toxicodynamic profiles
Intentional overdose with insulin: prognostic factors and toxicokinetic/toxicodynamic profiles
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DOI：
10.1186/cc6168
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发表时间：
2007-01-01
期刊：
影响因子：
15.1
通讯作者：
Baud, Frederic J.
中科院分区：
文献类型：
--
作者：
Megarbane, Bruno;Deye, Nicolas;Baud, Frederic J.
前言：胰岛素中毒的预后因素和血浆胰岛素水平的意义尚不清楚。方法采用前瞻性研究方法，采用Logistic回归方法，对影响胰岛素中毒患者的预后因素和毒代动力学/毒代动力学关系进行建模研究。结果纳入患者25例，女性14例，男性11例，年龄中位数为46[36~58]岁。入院时格拉斯哥昏迷评分为9分(4~14分)，血糖值为1.4(1.1~2.3)mmol/L，血胰岛素浓度为197(161~1,566)mLU/L，累计输注量为301(184~1,056)g，4例出现后遗症，2例死亡。延迟治疗超过6小时(优势比60.0，95%可信区间2.9~1 2 36.7)和超过48小时(优势比2 8.5，95%可信区间1.9~420.6)是影响预后的独立因素。葡萄糖输注速率和胰岛素浓度之间的毒代动力学/毒理动力学关系符合最大葡萄糖输注速率(E-max)模型(Emax为29.5[17.5~41.1]g/h，浓度与半最大葡萄糖输注速率[EC50]46[35~161]mLU/L相关，R2范围为0.70~0.98；n=6)。预后评估依赖于临床结果。观察到的血浆胰岛素EC50为46mLU/L。
Introduction Prognostic factors in intentional insulin self-poisoning and the significance of plasma insulin levels are unclear. We therefore conducted this study to investigate prognostic factors in insulin poisoning, in relation to the value of plasma insulin concentration.Methods We conducted a prospective study, and used logistic regression to explore prognostic factors and modelling to investigate toxicokinetic/toxicodynamic relationships.Results Twenty-five patients (14 female and 11 male; median [25th to 75th percentiles] age 46 [ 36 to 58] years) were included. On presentation, the Glasgow Coma Scale score was 9 (4 to 14) and the capillary glucose concentration was 1.4 (1.1 to 2.3) mmol/l. The plasma insulin concentration was 197 (161 to 1,566) mlU/l and the cumulative amount of glucose infused was 301 (184 to 1,056) g. Four patients developed sequelae resulting in two deaths. Delay to therapy in excess of 6 hours (odds ratio 60.0, 95% confidence interval 2.9 to 1,236.7) and ventilation for longer than 48 hours (odds ratio 28.5, 95% confidence interval 1.9 to 420.6) were identified as independent prognostic factors. Toxicokinetic/toxicodynamic relationships between glucose infusion rates and insulin concentrations fit the maximum measured glucose infusion rate (E-max) model ( Emax 29.5 [17.5 to 41.1] g/hour, concentration associated with the half-maximum glucose infusion rate [EC50] 46 [35 to 161] mlU/l, and R-2 range 0.70 to 0.98; n = 6).Conclusion Intentional insulin overdose is rare. Assessment of prognosis relies on clinical findings. The observed plasma insulin EC50 is 46 mlU/l.