Wang Susan, Rizvi Ali A
Department of Medicine, University of South Carolina School of Medicine, Columbia, South Carolina 29203, USA.
Am J Med Sci. 2006 Jun;331(6):334-5. doi: 10.1097/00000441-200606000-00009.
The fluoroquinolones can cause severe hypoglycemia in older individuals with diabetes who are taking oral hypoglycemic agents. We describe a patient without diabetes who had new-onset hypoglycemia when given oral levaquin for pneumonia that developed after cardiac bypass surgery. The condition manifested with profound neurologic disturbances and required intravenous dextrose and parenteral glucagon for treatment. No other cause could be identified, and the problem remitted a few days after administration of the antibiotic was stopped. Laboratory evaluation showed relatively inappropriate insulin elevation at the time of the hypoglycemic episodes, consistent with pancreatic beta-cell stimulation. The report highlights glucose-lowering as an adverse effect of the fluoroquinolone class of antibiotics in persons without diabetes or taking hypoglycemic medication. Although levaquin is useful as broad-spectrum therapy in a variety of situations, clinicians should be cognizant of the occurrence of potentially serious or even fatal hypoglycemia with its use.
氟喹诺酮类药物可使正在服用口服降糖药的老年糖尿病患者发生严重低血糖。我们描述了一名无糖尿病患者，在接受口服左氧氟沙星治疗心脏搭桥手术后发生的肺炎时出现了新发低血糖。该病症表现为严重的神经功能障碍，需要静脉输注葡萄糖和注射胰高血糖素来治疗。未发现其他病因，停用抗生素几天后问题得到缓解。实验室评估显示，低血糖发作时胰岛素升高相对不适当，这与胰腺β细胞受刺激一致。该报告强调，在无糖尿病或未服用降糖药物的人群中，降糖是氟喹诺酮类抗生素的一种不良反应。尽管左氧氟沙星在多种情况下作为广谱治疗药物很有用，但临床医生应认识到使用该药可能会发生严重甚至致命的低血糖。
