1/8
You start SQ insulin on a patient and they develop peripheral edema ?
What is the mechanism of "Insulin edema" ?
#MedTwitter #MedStudentTwitter
You start SQ insulin on a patient and they develop peripheral edema ?
What is the mechanism of "Insulin edema" ?
#MedTwitter #MedStudentTwitter
2/8
This condition was initially reported by Aaron Leifer, M.D. in 1928 in a 41-year-old male patient started on an insulin regimen which was published in JAMA.
Leifer A. A CASE OF INSULIN EDEMA. JAMA. 1928;90(8):610–611. doi:10.1001/jama.1928.92690350001012
This condition was initially reported by Aaron Leifer, M.D. in 1928 in a 41-year-old male patient started on an insulin regimen which was published in JAMA.
Leifer A. A CASE OF INSULIN EDEMA. JAMA. 1928;90(8):610–611. doi:10.1001/jama.1928.92690350001012
3/8
The severity of edema is usually mild, involving the limbs, sparing the torso and face.
Resolution is usually seen after one to two weeks of conservative treatment with fluid and salt restriction and may or may not involve the use of diuretics
grepmed.com
The severity of edema is usually mild, involving the limbs, sparing the torso and face.
Resolution is usually seen after one to two weeks of conservative treatment with fluid and salt restriction and may or may not involve the use of diuretics
grepmed.com
4/8
The mechanism is thought to be:
1) ⬇️insulin results in a catabolic state ➡️edema
2)Chronic hyperglycemia ⬆️capillary permeability through the leak of albumin into the interstitial fluid
The mechanism is thought to be:
1) ⬇️insulin results in a catabolic state ➡️edema
2)Chronic hyperglycemia ⬆️capillary permeability through the leak of albumin into the interstitial fluid
5/8
3)Intensive fluid resuscitation during the initial phase of treatment can ⬆️ edema
4) Insulin ⬆️ renal tubular sodium reabsorption by stimulating the Na+/K+-ATPase proximal tubule
5) Insulin ⬇️ Glucagon which has a natriuretic effect.
ahajournals.org
3)Intensive fluid resuscitation during the initial phase of treatment can ⬆️ edema
4) Insulin ⬆️ renal tubular sodium reabsorption by stimulating the Na+/K+-ATPase proximal tubule
5) Insulin ⬇️ Glucagon which has a natriuretic effect.
ahajournals.org
6/8
Therefore:
⬆️ Renal tubular sodium reabsorption + increased capillary permeability works in tandem to promote the edematous state.
#references" target="_blank" rel="noopener" onclick="event.stopPropagation()">cureus.com
Therefore:
⬆️ Renal tubular sodium reabsorption + increased capillary permeability works in tandem to promote the edematous state.
#references" target="_blank" rel="noopener" onclick="event.stopPropagation()">cureus.com
7/8
DDx to be considered:
-refeeding syndrome
-malnutrition
Treatment:
Short-term diuretics and salt restriction
DDx to be considered:
-refeeding syndrome
-malnutrition
Treatment:
Short-term diuretics and salt restriction
8/8
The severity of edema is usually mild, involving the limbs
Severe occurrences with generalized anasarca, pleural effusions, and ascites are rare but have been reported.
The severity of edema is usually mild, involving the limbs
Severe occurrences with generalized anasarca, pleural effusions, and ascites are rare but have been reported.
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