A Case Report: Fatal Mesenteric Microvascular Compromise Following Methamphetamine use and Insulin Overdose Treated...

Severe hypoglycemia from insulin overdose is a medical emergency that can be complicated by comorbidities and concurrent substance use. This case highlights a rare but fatal outcome of acute mesenteric ischemia in a patient with insulin overdose treated with Octreotide (Sandostatin, Novartis), compounded by recent methamphetamine use. The interplay of these factors may contribute to microvascular compromise and ischemia.

A 44-year-old male with chronic kidney disease stage 3b, body-mass-index of 23.23 kg/m2, insulin-dependent diabetes mellitus, and recent methamphetamine use presented with altered mental status following a self-reported insulin overdose of 240 units. Initial management included high-dose dextrose infusions, yet severe hypoglycemia persisted. Octreotide was administered to suppress endogenous insulin secretion, resulting in initial stabilization and resolution of altered mental status. Approximately five hours later, the patient developed acute abdominal pain, worsening encephalopathy, and respiratory distress requiring intubation. Computed tomography angiography revealed extensive portal and mesenteric venous gas. Emergency laparotomy revealed evidence of widespread microvascular ischemia but no full-thickness intestinal infarction, suggestive of non-occlusive mesenteric ischemia (NOMI). Despite surgical intervention and aggressive resuscitation, the patient deteriorated and succumbed to his illness.

This case highlights the critical importance of considering methamphetamine use and its potential synergistic effects with medications like octreotide in the management of complex medical conditions to prevent fatal complications such as severe intestinal ischemia.