Korean J Intern Med.  2006 Sep;21(3):206-209. 10.3904/kjim.2006.21.3.206.

Hepatic Subcapsular Steatosis in a Diabetic CAPD Patient Receiving Intraperitoneal Insulin

• Jang EC
• Kim G
• Kim YS
• Yoon SA
• Ku YM
• Yang CW
• Kim YO

• KMID: 759851
• DOI: http://doi.org/10.3904/kjim.2006.21.3.206

Abstract

Hepatic subcapsular steatosis is a rare and specific form of fatty change in the liver. It is a unique finding in diabetic patients receiving continuous ambulatory peritoneal dialysis (CAPD) and intraperitoneal insulin treatment. Intraperitoneal administration of insulin causes a unique pattern of fatty infiltration in the subcapsular location of the liver. Here we report a case of hepatic subcapsular steatosis in a diabetic CAPD patient who received intraperitoneal insulin. A 46-year-old diabetic woman on CAPD presented with general weakness. The patient received a total amount of 110 units of regular insulin via intraperitoneal and subcutaneous injection. Her initial blood chemistry showed increased serum lipid and liver enzyme profiles. Abdominal CT scan images and MRI revealed characteristic findings consistent with hepatic subcapsular steatosis. We assumed that the cause was CAPD and concomitant intraperitoneal insulin treatment; therefore, the patient was switched from CAPD to hemodialysis (HD) and began to receive insulin subcutaneously. Two months after the beginning of HD, the hepatic subcapsular steatosis completely resolved.

Keyword

Fatty liver; Peritoneal dialysis; Diabetes mellitus

MeSH Terms

Peritoneal Dialysis, Continuous Ambulatory/*adverse effects
Middle Aged
Insulin/*administration & dosage/adverse effects
Injections, Intraperitoneal
Humans
Female
Fatty Liver/diagnosis/*etiology
Drug Monitoring
Diabetes Mellitus, Type 2/drug therapy/physiopathology/*therapy
*Diabetes Complications