Continuous Renal Replacement Therapy for Exogenous Insulin Antibody Syndrome with Diabetic Ketoacidosis：a Case Report

doi:10.12114/j.issn.1007-9572.2020.00.178

Abstract

Abstract: Exogenous insulin antibody syndrome （EIAS） is associated with insulin antibodies （IAB） induced by exogenous insulin in diabetic patients.Its main characteristic is body's resistance to insulin，with decreased glycemic control effect produced by a given concentration of insulin.Severe insulin resistance is defined as insulin requirements > 200 U/d.This article reports a 62-year-old woman with type 2 diabetes，who suffered from insulin resistance after treatment with insulin aspart 30 （NovoRapid 30 Mix） for 24 days，which further induced severe ketoacidosis，with the insulin requirement up to 100 U/h.Finally，continuous renal replacement therapy （CRRT） was used for 63 hours to treat serious acidosis，abidance hyperglycemia，and remove the circulating antibodies，and the patient's condition improved gradually.This report suggests that patients with EIAS and diabetic ketoacidosis should be treated with CRRT early，when using glucocorticoids and increasing insulin doses can not control the symptoms of acidosis and hyperglycemia，by which a poor prognosis may be prevented

Key words: Exogenous insulin antibody syndrome, Diabetic ketoacidosis, Insulin resistance, Continuous renal replacement therapy, Case reports

摘要： 外源性胰岛素抗体综合征（EIAS）与外源性胰岛素诱导糖尿病患者产生胰岛素抗体（IAB）有关，其主要特点是机体产生胰岛素抵抗，葡萄糖对给定浓度的胰岛素反应不足，严重胰岛素抵抗被定义为胰岛素需求量>200 U/d。本文报道了2009-05-25华北理工大学附属医院收治的1例62岁女性2型糖尿病患者，在皮下注射门冬胰岛素30 24 d后产生胰岛素抵抗，进而诱发了严重酮症酸中毒，胰岛素的用量最高达100 U/h，最终采用连续性肾脏替代治疗（CRRT）63 h纠正了严重酸中毒和严重高血糖状态、清除了躯体内的IAB，患者的病情逐渐好转。该病例提示在临床上，EIAS合并糖尿病酮症酸中毒患者使用糖皮质激素及增加胰岛素剂量不能改变其酸中毒和高血糖症状时，宜及早采用CRRT，避免不良预后的发生。

关键词: 外源性胰岛素抗体综合征, 糖尿病酮症酸中毒, 胰岛素抵抗, 连续性肾脏替代治疗, 病例报告

FAN Yaqing,JIN Xiuping. Continuous Renal Replacement Therapy for Exogenous Insulin Antibody Syndrome with Diabetic Ketoacidosis：a Case Report　[J]. Chinese General Practice, 2021, 24(8): 1033-1036. DOI: 10.12114/j.issn.1007-9572.2020.00.178.
樊雅晴,金秀平. 连续性肾脏替代治疗外源性胰岛素抗体综合征合并糖尿病酮症酸中毒一例报道[J]. 中国全科医学, 2021, 24(8): 1033-1036. DOI: 10.12114/j.issn.1007-9572.2020.00.178.

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