Acute hepatic steatosis complicating massive insulin overdose and excessive glucose administration

Objective: To describe a case of acute hepatic steatosis due to excessive administration of glucose in the setting of massive insulin overdose, a complication 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 (ASAT 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 ultrasound examination suggested acute hepatic steatosis. Clinical and laboratory abnormalities resolved rapidly after discontinuation of excessive glucose infusions (1,400 g/day for 3 days). Conclusions: Very large amounts of glucose after massive insulin overdose are potentially dangerous. Even though the fear of hypoglycemia-induced neurologic damage should be a constant preoccupation in this situation, glucose administration should be titrated on closely monitored blood glucose levels.