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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >Detection of surreptitious administration of analog insulin to an 8-week-old infant.
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Detection of surreptitious administration of analog insulin to an 8-week-old infant.

机译：对一个8周大的婴儿秘密给予类似胰岛素的检测。

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An 8-week-old infant presented to the emergency department with lethargy, tachycardia, and a blood glucose concentration of 1.8 mmol/L. After admission, hypoglycemia recurred on 3 additional occasions. Initial urinalysis results were negative for ketones, and the results of additional laboratory tests did not support the diagnosis of cortisol or growth hormone deficiency, oral hypoglycemic ingestion, or an inborn error of metabolism. Difficulty restoring and maintaining glucose concentrations along with a transient response to glucagon during 1 hypoglycemic episode suggested hyperinsulinism. In 1 hypoglycemic episode, elevated insulin and low C-peptide concentrations suggested exogenous insulin administration, but 2 subsequent blood samples obtained during hypoglycemia contained appropriately decreased concentrations of insulin. The insulin immunoassay initially used in this case (Roche ElecSys/cobas [Roche Diagnostics, Indianapolis, IN]) was insensitive to insulin analogs. Two additional immunoassays, 1 with intermediate (Immulite [Siemens, Deerfield, IL]) and 1 with broad (radioimmunoassay [Millipore, Inc, Billerica, MA]) reactivity to insulin analogs were used to characterize insulin in each of the critical blood samples. Samples obtained during hypoglycemia displayed a graded reactivity similar to that observed in type 1 diabetic patients prescribed insulin analogs, whereas a sample obtained from the patient and a control subject during euglycemia showed equal reactivity among the 3 assays. These data suggested administration of insulin analog to the child, and further characterization of insulin by using tandem mass spectrometry confirmed the presence of Humalog. The child was subsequently placed in foster care with no further recurrence of hypoglycemia.
机译：一名8周大的婴儿因嗜睡，心动过速和血糖浓度为1.8 mmol / L而被送往急诊科。入院后，低血糖症又再发生3次。最初的尿液分析结果为酮阴性，其他实验室检查的结果不支持诊断皮质醇或生长激素缺乏症，口服降糖摄入或先天性代谢错误。在1个降血糖事件中，难以恢复和维持葡萄糖浓度以及对胰高血糖素的短暂反应提示高胰岛素血症。在1次低血糖发作中，胰岛素升高和C肽浓度低提示外源性胰岛素给药，但是在低血糖期间获得的2个后续血液样本中胰岛素浓度适当降低。在这种情况下最初使用的胰岛素免疫测定法（Roche ElecSys / cobas [Roche Diagnostics，印第安纳波利斯，印第安纳州]）对胰岛素类似物不敏感。两种额外的免疫分析方法，其中一种具有对胰岛素类似物的反应性，其中一种具有中间体（伊姆利特[Immulite [Siemens，Deerfield，IL]），另一种具有广泛的（放射免疫分析[Millipore，Inc，Billerica，MA]）反应性，用于表征每个关键血样中的胰岛素。在低血糖期间获得的样品显示出与在开具胰岛素类似物的1型糖尿病患者中观察到的相似的分级反应性，而在正常血糖期间从患者和对照组受试者获得的样品在3种测定中显示出相同的反应性。这些数据表明向该儿童施用胰岛素类似物，并且通过使用串联质谱法进一步表征胰岛素证实了Humalog的存在。该孩子随后被送往寄养，不再发生低血糖症。

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