PMID: 11332378May 3, 2001Paper

Generalized edema following insulin treatment of newly diagnosed diabetes mellitus

Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række
P B JúlíussonP H Kvistad

Abstract

Generalised oedema after introducing insulin therapy is an infrequent complication, usually appearing when large doses are used in underweight patients. The pathophysiology is unclear. Two patients from two different hospitals are presented by case histories. A limited literature search was performed. Patient 1. A 13-year-old girl was admitted with polyuria and polydipsia and a weight loss of 15 kg over six months. She had ankle oedema, dry scaling skin, weight 31.6 kg (2 kg below 2.5th centile), marked hyperglycaemia (60 mmol/l), and ketonuria without acidosis. After one day with insulin infusion she was treated with subcutaneous injections, reaching after a few days a dose of 2 U/kg/day. She gradually developed generalised oedema and gained 20 kg over two weeks. From day 8 after admission she was treated with furosemide and from day 16 also with ephedrine. S-albumin reached a nadir of 25 g/l. The oedema gradually disappeared. The patient was discharged after one month, weighing 42 kg, and with a daily insulin dose of 88 U. Patient 2. A 14-year-old girl presented with decreased vision over a period of six months. She felt otherwise healthy and had no weight loss. Bilateral cataract and hyperglycaemia (20.7 mmol/l) were detecte...Continue Reading

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