Anaphylactic shock caused by biosynthetic human insulin injection
Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing 100053, China; Department of Pharmacy, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
Abstract：A 75-year-old female patient with diabetes mellitus was scheduled for surgery due to right distal radius fracture. She was given an IV infusion of 5% glucose and sodium chloride injection 500 ml + biosynthetic human insulin injection (Novolin R) 6 U during fasting before operation, and no other drugs were concomitantly used. Her fingerstick glucose was 10.6-mmol/L before the IV infusion. At about 3-minutes of fluid infusion (infused fluid was about 8-ml), the patient suddenly developed chills all over the body and nausea, followed by consciousness loss, no response to verbal stimuli, foam at mouth, convulsions of both upper limbs, and incontinence of urine. Finger-stick glucose was 9.6-mmol/L and hypoglycemic reaction could be ruled out. Electrocardiogram monitoring showed the lowest blood pressure 37/27-mmHg and oxygen saturation 0.40. Anaphylactic shock due to biosynthetic human insulin was considered. Anti-anaphylactic and anti-shock treatments such as intravenous pumping of dopamine and norepinephrine, subcutaneous injection of epinephrine, and intravenous infusion of dexamethasone were given successively. Three hours later, the patient returned to normal.
