JAMA : the journal of the American Medical Association
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Case Reports
Surreptitious insulin administration in adolescents with insulin-dependent diabetes mellitus.
Six adolescents, 12 to 15 years old, with insulin-dependent diabetes mellitus were discovered to be secretively taking extra insulin, not with the intent of improving metabolic control. Large discrepancies between reported and observed insulin requirements were noted. Psychosocial problems antedated the discovery of surreptitious insulin administration in all. ⋯ In two patients surreptitious insulin administration was believed to represent suicidal behavior. In others, it appeared to represent symptom substitution when use of other health-threatening behaviors such as recurrent ketoacidosis was made increasingly difficult through appropriate intervention. Surreptitious insulin administration may be one symptom of serious underlying psychiatric dysfunction in adolescents with insulin-dependent diabetes.
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Experience with the administration of high doses of interleukin 2 (IL-2) alone is described herein. Ten patients with a variety of malignant disorders unresponsive to conventional treatments were treated with at least 30,000 U/kg of IL-2 by bolus administration three times a day. Patients were treated intravenously or intraperitoneally from four to 21 days in a single course, usually interrupted by a week of recovery. ⋯ Progressive shrinkage of tumors for three to six months after the conclusion of therapy has been noted in two patients. Marked lymphocytic infiltrate was noted in a patient with lesions accessible to repeated biopsies. This study demonstrates that the administration of IL-2 can mediate the regression of established cancer in some patients.
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Eight cases of suicidal isoniazid overdose by Cambodian refugees are reviewed. In all patients generalized seizures and metabolic acidosis developed. ⋯ Psychiatric evaluation of each patient revealed usual and extraordinary life and social adjustment stresses. Indochinese immigrants are a subpopulation at risk for isoniazid overdose.