Metabolic acidosis as a complication of intravenous dextrose administration in a patient with insulinoma

Abstract

There are few cases published in literature in which the use of intravenous dextrose as treatment for an insulinoma resulted in a metabolic acidosis. This is due perhaps to the usual method of administration, which is usually at low concentrations, for limited periods or low volumes. We present the case of a woman with suspected insulinoma by laboratory findings in which an endogenous hyperinsulinism was observed. During hospitalization, the patient required a progressive increase of the glucose infusion to prevent severe hypoglycemia. Two days before surgery, the patient presented symptoms of malaise and muscle weakness and a metabolic acidosis with hypokalemia became apparent in the blood analysis. This metabolic imbalance was attributed to a long period of treatment with high volume of intravenous dextrose infusion. If large doses of dextrose are required in a patient with an insulinoma, then the possibility of a metabolic imbalance must be considered during the follow-up. When the suspicion of an insulinoma is high, and all the attempts of pre-operative localization fail, patients should be derived early to specialized centers with modern imaging techniques, so that surgery is not delayed, and this rare and threatening complication could be avoided.

Pancreatic Beta Cell Tumors

“…Sometimes endovenous glucose infusion may be needed to maintain acceptable glucose levels usually in the preopreatory or when it is a high secreting malignant insulinoma. Glucose infusion must be done with care as patients may develop in rare cases acidosis secondary to large volumes of glucose infusion (Ramos,A., et al, 2010). When diet modification does not control the symptoms, pharmacological treatment must be used.…”