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Information concerning administration and duration of intravenous (<jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content>) glucose, other treatment options or complications besides hypoglycaemia following large insulin overdoses is not readily apparent from the literature. A systematic search, compilation and review of case reports on insulin overdoses, published 1986\u20132017, was performed in PubMed, <jats:styled-content style=\"fixed-case\">EMBASE<\/jats:styled-content>, Cochrane and <jats:styled-content style=\"fixed-case\">PROSPERO<\/jats:styled-content> databases. Of 1523 published articles, 45 cases of insulin overdoses were included with a total median insulin dose of 900 international units (<jats:styled-content style=\"fixed-case\">IU<\/jats:styled-content>) (range 26\u20134800 <jats:styled-content style=\"fixed-case\">IU<\/jats:styled-content>). Hospitalization occurred in 44 cases with a median hospitalization duration of 94 hr (range 12\u2013721 hr), and one\u2010third (n = 15) admitted to the intensive care unit. First\u2010line treatment was <jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content> glucose treatment in 95% of cases. Treatment options besides IV glucose that were reported beneficial included glucagon <jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content> or intramuscular (<jats:styled-content style=\"fixed-case\">IM<\/jats:styled-content>), octreotide <jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content> or <jats:styled-content style=\"fixed-case\">IM<\/jats:styled-content>, surgical excision, hydrocortisone <jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content> and oral intake of complex carbohydrates. Prevalent complications were intermittent cerebral impairment (73%), hypokalaemia (49%), other electrolyte disturbances (42%), and hepatic disturbances (7%) and cardiac toxicity (e.g. cardiac arrhythmia) (9%). Long\u2010term consequences were one case of lasting hypoglycaemic encephalopathy and one death. In conclusion, following large insulin overdoses, in\u2010hospital admission and treatment with <jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content> glucose may be needed for up to a week. Monitoring of electrolytes and hepatic and cardiac functions seems important. Several experimental treatment options may be considered in addition to glucose administration. With appropriate pre\u2010 and in\u2010hospital treatment, cases with severe hypoglycaemia and neurologic complications may have a favourable outcome.<\/jats:p>","DOI":"10.1111\/bcpt.12957","type":"journal-article","created":{"date-parts":[[2018,1,10]],"date-time":"2018-01-10T13:13:14Z","timestamp":1515589994000},"page":"650-659","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":43,"title":["A Systematic Review on Insulin Overdose Cases: Clinical Course, Complications and Treatment Options"],"prefix":"10.1111","volume":"122","author":[{"given":"Nicklas J\u00e4rvel\u00e4","family":"Johansen","sequence":"first","affiliation":[{"name":"Department of Clinical Pharmacology Bispebjerg Hospital University of Copenhagen Copenhagen Denmark"},{"name":"Steno Diabetes Center Copenhagen University of Copenhagen Gentofte Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikkel Bring","family":"Christensen","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacology Bispebjerg Hospital University of Copenhagen Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,2,23]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"http:\/\/www.diabetesatlas.org\/September2017"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1177\/070674379403900207"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1463-1326.2012.01580.x"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2014.136"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc12-0749"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.26.6.1902"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198611133152002"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.3111\/13696998.2015.1086775"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2013.03.805"},{"key":"e_1_2_9_11_1","unstructured":"DriverBE PandeyV HarringtonJJ LaiT ZhaoS SwiggumMet al.Insulin administration to patients without diabetes is a common cause of iatrogenic hypoglycaemia in the emergency department. 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