| Detection of surreptitious administration of analog insulin to an 8-week-old infant. | |
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MedLine Citation:
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PMID: 20385635 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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An 8-week-old infant presented to the emergency department with lethargy, tachycardia, and a blood glucose concentration of 1.8 mmol/L. After admission, hypoglycemia recurred on 3 additional occasions. Initial urinalysis results were negative for ketones, and the results of additional laboratory tests did not support the diagnosis of cortisol or growth hormone deficiency, oral hypoglycemic ingestion, or an inborn error of metabolism. Difficulty restoring and maintaining glucose concentrations along with a transient response to glucagon during 1 hypoglycemic episode suggested hyperinsulinism. In 1 hypoglycemic episode, elevated insulin and low C-peptide concentrations suggested exogenous insulin administration, but 2 subsequent blood samples obtained during hypoglycemia contained appropriately decreased concentrations of insulin. The insulin immunoassay initially used in this case (Roche ElecSys/cobas [Roche Diagnostics, Indianapolis, IN]) was insensitive to insulin analogs. Two additional immunoassays, 1 with intermediate (Immulite [Siemens, Deerfield, IL]) and 1 with broad (radioimmunoassay [Millipore, Inc, Billerica, MA]) reactivity to insulin analogs were used to characterize insulin in each of the critical blood samples. Samples obtained during hypoglycemia displayed a graded reactivity similar to that observed in type 1 diabetic patients prescribed insulin analogs, whereas a sample obtained from the patient and a control subject during euglycemia showed equal reactivity among the 3 assays. These data suggested administration of insulin analog to the child, and further characterization of insulin by using tandem mass spectrometry confirmed the presence of Humalog. The child was subsequently placed in foster care with no further recurrence of hypoglycemia. |
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Authors:
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Rebecca P Green; Abby S Hollander; Mario Thevis; Andreas Thomas; Dennis J Dietzen |
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Publication Detail:
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Type: Case Reports; Journal Article Date: 2010-04-12 |
Journal Detail:
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Title: Pediatrics Volume: 125 ISSN: 1098-4275 ISO Abbreviation: Pediatrics Publication Date: 2010 May |
Date Detail:
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Created Date: 2010-05-03 Completed Date: 2010-05-18 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0376422 Medline TA: Pediatrics Country: United States |
Other Details:
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Languages: eng Pagination: e1236-40 Citation Subset: AIM; IM |
Affiliation:
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Department of Pediatrics, Washington University, St Louis, MO 63110, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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C-Peptide
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blood Diabetes Mellitus, Type 1 / drug therapy Diagnosis, Differential Emergency Service, Hospital Female Glucagon / blood Humans Hyperinsulinism / blood, chemically induced*, diagnosis Hypoglycemia / blood, chemically induced*, diagnosis Hypoglycemic Agents / administration & dosage, toxicity* Infant Insulin / administration & dosage, analogs & derivatives*, blood, toxicity Male Munchausen Syndrome by Proxy / diagnosis*, psychology Pregnancy Pregnancy in Diabetics / drug therapy Recurrence |
| Chemical | |
Reg. No./Substance:
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0/C-Peptide; 0/Hypoglycemic Agents; 0/insulin aspart; 11061-68-0/Insulin; 9007-92-5/Glucagon |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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