Megarbane et al identified prognostic factors in patients who had an intentional insulin overdose. These can help identify patients who may benefit from more aggressive management. The authors are from Hopitaux de Paris.
Poor outcome:
(1) death
(2) severe neurological impairment on discharge from the ICU
Parameters:
(1) time interval in hours between injection and starting a dextrose infusion
(2) duration of mechanical ventilation in hours
Parameter
Finding
Points
time interval before a dextrose infusion is started
<= 6 hours
0
> 6 hours
1
duration of mechanical ventilation
<= 48 hours
0
> 48 hours
1
where:
• The duration of mechanical ventilation is a surrogate marker for the severity of the hypoglycemic encephalopathy. An alternative measure is the duration of the hypoglycemic coma.
• The dose and type of insulin affected the duration of the hypoglycemia but not its severity.
number of prognostic factors associated with a poor outcome =
= SUM(points for the 2 parameters)
Interpretation:
• minimum number of poor prognostic factors: 0
• maximum number of poor prognostic factors: 2
• The greater the number of poor prognostic findings the worse the prognosis.
To read more or access our algorithms and calculators, please log in or register.
