A Case of Insulin Anasarca with Cardiac Failure
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This is a clinical description of a 35-year-old male, non-obese diabetic, who developed generalized edema including clinical manifestations of cardiac failure, following the institution of insulin therapy.<BR>The patient had been treated with glibenclamide (10 mg/day) but his fasting blood sugar remained as high as 235 mg/dl on admission. He showed slight dehydration but there were no findings of ketoacidosis.<BR>The oral hypoglycemic agent was switched to actrapid insulin soon after admission. On the third day of insulin therapy, however, weight gain and pitting edema in the lower extremities began to develop, along with rapid improvement of abnormal carbohydrate metabolism. On the seventh day, generalized edema with orthopnea developed. The chest X-ray revealed manifestation of congestive heart failure, with cardiac enlargement and pleural effusion. The administration of furosemide and reduction of the insulin dosage produced a prompt amelioration of edema as well as cardiac failure. Throughout the course, no signs of the impaired renal function were demonstrated.<BR>"Insulin edema", which has been described in some textbooks, is fairly unusual condtion and a development of "anasarca" accompanied by cardiac failure is considered to be exetremely rare.<BR>Pathogenesis of "insulin edema" has not been clearly understood. Some authors pointed out the presence of a close relationship between carbohydrate intake and Na retention, and others suggested that changes of the osmolarity between the tissue and the extracellular space following changes in the blood glucose levels play a significant role in the development of "insulin edema". In our case, however, we could not demonstrate any causative factors for the generalized edema with the laboratory examinations except for slight hypoalbuminemia on admission.<BR>It is finally emphasized that not only "insulin edema" but also congestive heart failure might be provoked by the rapid diabetic treatment, as shown in this patient.
- 一般社団法人 日本糖尿病学会の論文
一般社団法人 日本糖尿病学会 | 論文
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