MON-870 - Acute Transaminitis Related to High Dextrose Dose for Insulin Glargine Overdose

We present a case with insulin glargine overdose, treated with dextrose infusion and liberal diet intake, whose course was complicated by acute transaminitis. A 79-year-old man, known to have insulin-dependent diabetes mellitus, attempted suicide by injecting nearly 3,000 units of insulin glargine into multiple sites, including his neck. The patient was admitted to the ICU for insulin overdose with close monitoring of glucose, electrolytes, and EKG. He was on dextrose infusion with liberal oral intake. On admission, liver function tests were mildly elevated; however, following continued dextrose treatment, the levels significantly worsened. The ultrasound of the liver was unremarkable. Liver function test improved with decreasing dextrose doses, and he was asymptomatic on discharge to the Psychiatry hospital. Acute transaminitis has been reported in cases with insulin overdose treated with high doses of dextrose and high carbohydrate intake. However, the transaminitis is reversible with discontinuation of dextrose administration. Also, consideration should be given as to the appropriate time to resume anti-hyperglycemic drug therapy.

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