Reactions 1704, p202 - 2 Jun 2018 Severe allergic reaction: case report A 45-year-old man developed severe allergic reaction during treatment with insulin [human insulin]. The man presented to an emergency department with a chest pain and hyperglycaemia. He had a history of type 2 diabetes mellitus, for which he had been receiving anti- diabetic drug since two years. However, he had stopped anti- diabetic drug for a month. He was started on a treatment with IV bolus of insulin 0.1 unit/kg and sodium chloride [saline], followed by insulin infusion at a rate of 0.1 unit/kg/hour. At the 30 minutes of treatment, he developed a generalised skin rash, hoarseness and uvular oedema, which expanded to the soft palate. His vital findings revealed tachycardia, body temperature 36.0°C, BP 126/75mm Hg, respiration number 24 /minute, pulse rate 104 /minute and oxygen saturation 99%. Insulin-related allergic reaction was considered. The man’s insulin therapy was stopped. He received treatment with chlorphenoxamine hydrochloride, ranitidine, prednisolone and adrenaline. The uvula oedema did not resolve, despite treatment. He underwent an emergency haemodialysis because of severe metabolic acidosis. The treatment with antihistamines, steroids and adrenaline was re- initiated as his symptoms remained the same. He was intubated in order to secure the airway. Due to the ongoing complaints and ketoacidosis, he received SC insulin aspart. At day 3 of follow-up, uvula oedema, ketonaemia and metabolic acidosis resolved completely. On day 5, he was extubated and was subsequently discharged on day 23 on insulin glargine and nateglinide. Author comment: "We present treatment of a patient with [diabetic ketoacidosis] who developed an insulin allergy." Oray NC, et al. Severe allergic reaction to human insulin in the patient with diabetic ketoacidosis. Turkish Journal of Emergency Medicine 18: 40-41, No. 1, Mar 2018. Available from: URL: http://doi.org/10.1016/j.tjem.2017.07.004 - Turkey 803322964 0114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved Reactions 2 Jun 2018 No. 1704
Reactions Weekly – Springer Journals
Published: Jun 2, 2018
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