Be aware of critical drugs in emergency departments: An extreme iatrogenic insulin overdose via subcutaneous and intramuscular routes

Year 2021, , 37 - 40, 11.06.2021

Figen Coşkun , Sevilay Vural , Oğuz Eroğlu , Ertan Cömertpay Şenay Arıkan Durmaz

https://doi.org/10.33706/jemcr.834296

Cited By: 1

Abstract

Introduction: Insulin is a highly used parenteral medication in emergency departments. Although most severe insulin overdoses occur as suicide attempts, medication errors can be the reason. We aimed to highlight the potential medication errors in emergency departments due to the poor control of critical drugs like insulin and the similarities between the brand names of drugs, as we experienced during this case.
Case Report: We present a 75-year-old diabetic woman with an extreme insulin overdose. A total of 3000 UI of insulin was administered by subcutaneous and intramuscular routes. She developed typical and atypical episodes of hypoglycemia requiring intravenous dextrose, a high-calorie diet, and glucagon administration. Almost all of the classic side effects of glucagon occurred during her intensive care unit follow-up. She recovered without any sequela or recurrence of hypoglycemia at the end of 5 days of admission.
Conclusion: Insulin overdose can be a life-threatening condition by causing hypoglycemia. Albeit rare, insulin overdose can occur as a medication error in hospitals. To prevent such incidents for emergency departments, the medication errors should be objectively laid out, and proactive strategies should be integrated without adversely affecting acute care.

Keywords

insulin, overdose, misadministration, critical drugs, emergency department, medication error

References

• McDowell SE, Ferner HS, Ferner RE. The pathophysiology of medication errors: how and where they arise. Br J Clin Pharmacol 2009; 67 :605-13.
• Tan X, Gu D, Lin X, Fang H, Asakawa T. Investigation of the characteristics of medication errors and adverse drug reactions using pharmacovigilance data in China. Saudi Pharm J 2020; 28: 1190-6.
• Pham JC, Story JL, Hicks RW, Shore AD, Morlock LL, Cheung DS, et al. National study on the frequency, types, causes, and consequences of voluntarily reported emergency department medication errors. J Emerg Med 2011; 40: 485-92.
• Seoane-Vazquez E, Rodriguez-Monguio R, Alqahtani S, Schiff G. Exploring the potential for using drug indications to prevent look-alike and sound-alike drug errors. Expert Opin Drug Saf 2017; 16: 1103-9.
• Faber J, Azzugnuni M, Di Romana S, Vanhaeverbeek M. Fatal confusion between ‘Losec’ and ‘Lasix’. Lancet 1991; 337: 1286-7.
• Cohen MR. Medication errors: error No. 20. Know the patient’s diagnosis before you administer the drugs. Nursing 1978; 8 :74.
• Weant KA, Bailey AM, Baker SN. Strategies for reducing medication errors in the emergency department. Open Access Emerg Med 2014; 6: 45-55.
• Thewjitcharoen Y, Lekpittaya N, Himathongkam T. Attempted suicide by massive insulin injection:a case report and review of the literature. J Med Assoc Thai 2008; 91: 1920-4.
• Johansen NJ, Christensen MB. A Systematic Review on Insulin Overdose Cases: Clinical Course, Complications and Treatment Options. Basic Clin Pharmacol Toxicol 2018; 122: 650-9.
• Hawton K, Clements A, Simkin S, Malmberg M. Doctors who kill themselves: A study of methods used for suicide. Q J Med 2000; 93: 351-7.
• Sato Y, Mizuno Y, Suganuma K, Shiroto K, Ikeda T, Yamashita K, et al. Pharmacokinetics of insulin disappearance after massive overdosing. Endocr J 2018; 65: 1147-53.
• Monroe PS, Heck WD, Lavsa SM. Changes to medication-use processes after overdose of U-500 regular insulin. Am J Health Syst Pharm 2012; 69: 2089-93.