Acute pulmonary edema caused by hypoglycemia due to insulin overdose.

We report a very rare case of acute pulmonary edema caused by hypoglycemia from insulin overdose during an attempted suicide. A 16-year-old woman with type 1 diabetes was brought to our hospital because of hypoglycemic coma. She exhibited severe hypoxia; upon intubation, bloody froth poured out of the tube. Chest X-ray revealed bilateral infiltrates. Endocrinological data revealed high concentrations of catecholamines. This case indicates that pulmonary edema remains a potential complication of insulin overdose. The possible mechanisms of pulmonary edema associated with hypoglycemia are discussed.

[1]  A. Caixàs,et al.  Hypoglycemia and pulmonary edema: a forgotten association. , 2000, Diabetes care.

[2]  R. Holman,et al.  Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. , 1998 .

[3]  Uk-Prospective-Diabetes-Study-Group.  Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33) , 1998, The Lancet.

[4]  M. Niwa,et al.  Cardiologic complications of subarachnoid hemorrhage. , 1998 .

[5]  A. Andreoli,et al.  Cardiologic complications of subarachnoid hemorrhage. , 1998, Journal of neurosurgical sciences.

[6]  S. Mayer,et al.  Cardiac injury associated with neurogenic pulmonary edema following subarachnoid hemorrhage , 1994, Neurology.

[7]  S. Genuth,et al.  The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. , 1993, The New England journal of medicine.

[8]  N. Christensen,et al.  Plasma volume changes during hypoglycaemia: the effect of autonomic blockade , 1991, European journal of clinical investigation.

[9]  W. Zoghbi,et al.  Insulin Overdose in Eight Patients: Insulin Pharmacokinetics and Review of the Literature , 1985, Medicine.

[10]  E D Robin,et al.  Speculations on neurogenic pulmonary edema (NPE). , 2015, The American review of respiratory disease.

[11]  L. Sherman,et al.  Hypoglycemia, a cause of pulmonary edema. Progressive, fatal pulmonary edema complicating hypoglycemia induced by alcohol and insulin. , 1975, Journal of the National Medical Association.

[12]  B. Goetzman,et al.  Hypoxia and iodoacetic acid and alveolocapillary barrier permeability to albumin. , 1970, The American journal of physiology.

[13]  W. Maclay.  Death Due to Treatment , 1953, Proceedings of the Royal Society of Medicine.

[14]  Maclay Ws.  Death due to treatment. , 1953 .

[15]  K. Blum,et al.  ACUTE PULMONARY ŒDEMA WITH HYPOGLYCÆMIC COMA , 1942, Journal of neurology and psychiatry.

[16]  J. Nielsen,et al.  PULMONARY EDEMA AND EMBOLISM: AS COMPLICATIONS OF INSULIN SHOCK IN THE TREATMENT OF SCHIZOPHRENIA , 1938 .

[17]  I. M. Rabinowitch.  INSULIN OEDEMA. , 2022, Canadian Medical Association journal.