Mah Jordan Kit, Negreanu Daniel, Radi Suhaib, Christopoulos Stavroula
Department of Internal Medicine, McGill University, Montreal, Quebec, Canada.
Endocrine Oncology, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
BMJ Case Rep. 2021 May 7;14(5):e240232. doi: 10.1136/bcr-2020-240232.
Trimethoprim-sulfamethoxazole (TMP-SMX) is a commonly prescribed antimicrobial agent for a wide variety of infections. It is generally well tolerated in a majority of patients; however, serious adverse effects have been described with its usage. Hypoglycaemia is an exceedingly rare but potentially life-threatening side effect of this antimicrobial agent due to its sulfonylurea-like effect. We describe a case of symptomatic, refractory hypoglycaemia secondary to TMP-SMX in a patient being treated for bacteraemia, which required treatment with 10 hours of intravenous dextrose (including several 50% dextrose boluses), as well as intramuscular glucagon and octreotide. We reviewed previous case reports described in the literature of TMP-SMX-induced hypoglycaemia, in which renal insufficiency was noted to be a common predisposing risk factor in an overwhelming majority of cases. In refractory cases of TMP-SMX-induced hypoglycaemia, intravenous octeotride may be considered for treatment.
甲氧苄啶-磺胺甲恶唑（TMP-SMX）是一种常用于治疗多种感染的抗菌药物。大多数患者对其耐受性良好；然而，使用该药物也出现过严重不良反应。低血糖是这种抗菌药物极其罕见但可能危及生命的副作用，因其具有磺酰脲样效应。我们报告一例在治疗菌血症过程中继发于TMP-SMX的症状性难治性低血糖病例，该病例需要静脉输注葡萄糖10小时（包括多次50%葡萄糖推注）以及肌肉注射胰高血糖素和奥曲肽进行治疗。我们回顾了文献中描述的既往TMP-SMX诱导低血糖的病例报告，其中绝大多数病例中肾功能不全是常见的易感风险因素。在TMP-SMX诱导低血糖的难治性病例中，可考虑使用静脉注射奥曲肽进行治疗。
