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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
A. Marthur, P. Gorden, S.K. Libutti, Insulinom. Surg. Clin. North Am. 89(5), 1105–1121 (2009)
R. Krysiak, B. Okopien, Z.S. Hermans, Insulinoma. Pol. Merkur. Lekarski 22(127), 70–74 (2007)
W. de Herder, B. Niederle, J.Y. Scoazec, S. Pauwels, G. Kloppel, M. Falconi, D.J. Kwekkeboom, K. Oberg, B. Eriksson, B. Wiedemann, G. Rindi, D. O′Toole, D. Ferone, Well-differentiated pancreatic tumor/carcinoma: insulinoma. Neuroendocrinology 84(3), 183–188 (2006)
P. Priego, A. Sanjuanbenito, E. Martínez-Molina, E. Lobo, D. García-Teruel, V. Morales, G. Rodríguez, V. Fresneda, Manejo diagnóstico y terapéutico del insulinoma pancreático. Rev. Esp. Enferm. Dig. 99(4), 218–222 (2007)
R.V. Thakker, Molecular genetics and patient management of multiple endocrine neoplasia type 1. Endocr. Surg. 15, 189–212 (2001)
M.L. Virally, P.J. Guillausseau, Hypoglycemia in adults. Diabetes Metab. 25, 477–490 (1999)
B. Abboud, J. Boujaoude, Occult sporadic insulinoma: localization and surgical strategy. World J. Gastroenterol. 14(5), 657–665 (2008)
A.K. Galiber, C.C. Reading, J.W. Charboneau, P.F. Sheedy, E.M. James, B. Gorman, C.S. Grant, J.A. van Herden, R.L. Telander, Localization of pancreatic insulinoma: comparison of pre- and intraoperative US with CT and angiography. Radiology 166, 405–408 (1988)
K. Ravi, B.J. Britton, Surgical approach to insulinomas: are preoperative localization tests necessary? Ann. R. Coll. Surg. Engl. 89, 850–856 (2007)
J.Y. Mabrut, J.C. Lifante, S. Cherki, Is preoperative localization of insulinomas necessary? Ann. Chir. 126, 850–856 (2001)
R. Sotoudehmanesh, A. Hedayat, N. Shirazian, S. Shahraeeni, S. Ainechi, F. Zeinali, S. Kolahdoozan, Endoscopic ultrasonography (EUS) in the localization of insulinoma. Endocrine 31, 238–241 (2007)
H. Gouya, O. Vignaux, J. Augui, CT, endoscopic sonography, and a combined protocol for preoperative evaluation of pancreatic insulinomas. AJR Am. J. Roentgenol. 181, 987–992 (2003)
J.S. Hiramoto, V.A. Feldstein, J.M. LaBerge, J.A. Norton, Intraoperative ultrasound and preoperative localization detects all occult insulinomas. Arch. Surg. 136, 1020–1025 (2001)
F. Kokot, L. Hyla-Klekot, Drug abnormalities of potassium metabolism. Pol. Arch. Med. Wewn. 118(7–8), 431–434 (2008)
P. Ahee, A.V. Crowe, The management of hyperkalaemia in the emergency department. J. Accid. Emerg. Med. 17(3), 188–191 (2000)
A. Katz, K. Sahlin, Regulation of lactic acid production during excersice. J. Appl. Physiol. 65, 509–518 (1988)
C. Soler-Morejón, Acidosis láctica. Rev. Cubana Med. 39(2), 115–119 (2000)
A. Freminet, C. Poyart, Lactate-glucose interrelations, glucose recycling and the Cori Cycle in normal fed rats. Pflügers Arch. 361, 25–31 (1975)
P.H. Winocour, K.J. Moriarty, C.N. Hales, J. Adams, R. Reeve, D. Wynick, D. Allison, S.R. Bloom, D.C. Anderson, Difficulties in localization and treatment of insulinomas in type 1 multiple endocrine adenomatosis (MEA). Postgrad. Med. J. 68, 196–200 (1992)
P. Jolliet, X. Leverve, C. Pichard, Acute hepatic steatosis complicating massive insulin overdose and excessive glucose administration. Intensive Care Med. 27, 313–316 (2001)
M.K. Hellerstein, J.M. Schwarz, R.A. Neese, Regulation of hepatic de novo lipogenesis in humans. Annu. Rev. Nutr. 16, 523–527 (1996)
N.M. Delzenne, N.A. Hernaux, H.S. Taper, A new model of acute liver steatosis induced in rats by fasting followed by reffeding a high carbohydrate-fat free diet. Biochemical and morpholgical analysis. J. Hepatol. 26, 880–885 (1997)
D. Hermier, Lipoprotein metabolism and fattening in poultry. J. Nutr. 127, 805S–808S (1997)
L. Day, C. Shikuma, M. Gerschenson, Mitochondrial injury in the pathogenesis of antiretroviral-induced hepatic steatosis and lactic acidemia. Mitochondrion 4(2–3), 95–109 (2004)
E. Bustamante, P.L. Pedersen, High aerobic glycolysis of rat hepatoma cells in culture: role of mitochondrial hexokinasa. Proc. Natl. Acad. Sci. 74(9), 3735–3739 (1977)
Conflict of interest
This study was not supported by any funding, and no author has a real or perceived conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ramos-Prol, A., del Olmo-García, M., Pérez-Lázaro, A. et al. Metabolic acidosis as a complication of intravenous dextrose administration in a patient with insulinoma. Endocr 38, 402–405 (2010). https://doi.org/10.1007/s12020-010-9400-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12020-010-9400-y