Use of Mannitol in Prolonged Coma Due to Insulin Overdose

Hoffbrand, B I; Sevitt, L.H.

doi:10.1016/s0140-6736(66)91395-x

Cited by 9 publications

(2 citation statements)

References 5 publications

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“…Coma that persists in comatose hypoglycaemic patients after restoration of blood glucose concentration to normal has been ascribed to cerebral oedema, and treated with mannitol. 30 Nineteen of the patients in the open-label study of the treatment of hypoglycaemic coma in 100 patients with diabetes were treated with mannitol infusion. 14 Two of the mannitol-treated patients died.…”

Section: From Experimental Studiesmentioning

confidence: 99%

Treatment of insulin poisoning: A 100‐year review

Moyns

Ferner

2023

Diabet Med

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Background: Insulin poisoning, as opposed to hypoglycaemia induced by therapeutic doses of insulin, is rare, and guidelines on management differ. We have reviewed the evidence on treatment of insulin poisoning. Methods:We searched PubMed, EMBASE and J-Stage with no restrictions of date or language for controlled studies on treatment of insulin poisoning, collected published cases of insulin poisoning from 1923, and used data from the UK National Poisons Information Service. Results:We identified no controlled trials of treatment in insulin poisoning and few relevant experimental studies. Case reports described 315 admissions (301 patients) with insulin poisoning between 1923 and 2022. The insulin with the longest duration of action was long-acting in 83 cases, medium-acting in 116, short-acting in 36 and a rapid-acting analogue in 16. Decontamination by surgical excision of the injection site was reported in six cases. To restore and maintain euglycaemia, almost all cases were treated with glucose, infused for a median 51 hours, interquartile range 16-96 h in 179 cases; 14 patients received glucagon and nine octreotide; adrenaline was tried occasionally. Both corticosteroids and mannitol were occasionally given to mitigate hypoglycaemic brain damage.There were 29 deaths reported, 22/156 (86% survival) up to 1999 and 7/159 (96% survival) between 2000 and 2022 (p = 0.003). Conclusions:There is no randomized controlled trial to guide treatment of insulin poisoning. Treatment with glucose infusion, sometimes supplemented with glucagon, is almost always effective in restoring euglycaemia, but optimum treatments to maintain euglycaemia and restore cerebral function remain uncertain.

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Section: From Experimental Studiesmentioning

confidence: 99%

Treatment of insulin poisoning: A 100‐year review

Moyns

Ferner

2023

Diabet Med

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“…Hoffbrand and Sevitt (1966) having observed extreme oedema of the brain at the necropsy of a young diabetic who died in hypoglycaemic coma decided to treat similar cases, who remained unconscious after glucose, with an intravenous infusion of mannitol. Their first case was a 73-year-old man who failed to respond to intravenous glucose and hydrocortisone; after having been un conscious for 12 h he was given 200 ml of 20% mannitol intrave nously over 15 min; some 30 min later the patient sat up and he rapidly recovered full consciousness.…”

Section: Hypoglycaemiamentioning

confidence: 99%