Acute hepatic steatosis complicating massive insulin overdose and excessive glucose administration

Objective: To describe a case of acute hepatic steatosis due to excessive a dministration of glucose in the setting of massive insulin overdose, a comp lication which is rapidly and completely reversible if glucose infusion is rapidly tapered. Design: Case report, clinical. Setting: Intensive care unit, university hospital. Patient: A single patient admitted to the ICU. Intervention: Intravenous glucose after insulin overdose. Measurements and main results: On the 3rd day, increases in transaminase (A SAT 420 IU/l, ALAT 610 IU/l),bilirubin (147 mmol/l) and lactate (6.8 mmol/l ), a decrease in arterial pH (7.32) and slightly increased liver size on ul trasound examination suggested acute hepatic steatosis. Clinical and labora tory abnormalities resolved rapidly after discontinuation of excessive gluc ose infusions (1,400 g/day for 3 days). Conclusions: Very large amounts of glucose after massive insulin overdose a re potentially dangerous. Even though the fear of hypoglycemia-induced neur ologic damage should be a constant preoccupation in this situation, glucose administration should be titrated on closely monitored blood glucose level s.