Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China.
Department of General Surgery, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China.
Front Endocrinol (Lausanne). 2023 Feb 8;14:1059522. doi: 10.3389/fendo.2023.1059522. eCollection 2023.
Hypoglycemia is a sporadic and serious adverse reaction of trimethoprim-sulfamethoxazole (TMP-SMX) due to its sulfonylurea-like effect. This study explored the clinical characteristics, risk factors, treatment, and prognosis of TMP-SMX-induced hypoglycemia.
Case reports and series of TMP-SMX-induced hypoglycemia were systematically searched using Chinese and English databases. Primary patient and clinical information were extracted for analysis.
A total of 34 patients were reported from 31 studies (16 males and 18 females). The patients had a median age of 64 years (range 0.4-91), and 75.8% had renal dysfunction. The median duration of a hypoglycemic episode was six days (range 1-20), and the median minimum glucose was 28.8 mg/dL (range 12-60). Thirty-two patients (97.0%) showed neuroglycopenic symptoms, with consciousness disturbance (30.3%) and seizure (24.2%), sweating (18.2%), confusion (15.2%), asthenia (12.1%) being the most common symptoms. Fifteen patients (44.1%) had elevated serum insulin levels, with a median of 31.8 μU/mL (range 3-115.3). C-peptide increased in 13 patients (38.2%), with a median of 7.7 ng/mL (range 2.2-20). Complete recovery from symptoms occurred in 88.2% of patients without sequelae. The duration of hypoglycemia symptoms was 8 hours to 47 days after the intervention. Interventions included discontinuation of TMP-SMX, intravenous glucose, glucagon, and octreotide.
Hypoglycemia is a rare and serious adverse effect of TMP-SMX. Physicians should be aware of this potential adverse effect, especially in patients with renal insufficiency, increased drug doses, and malnutrition.
由于磺胺甲噁唑-甲氧苄啶（TMP-SMX）具有磺酰脲类作用，低血糖是其一种偶发且严重的不良反应。本研究旨在探讨 TMP-SMX 引起的低血糖的临床特征、危险因素、治疗方法和预后。
通过中文和英文数据库系统检索 TMP-SMX 引起的低血糖病例报告和系列研究。提取主要的患者和临床信息进行分析。
共 31 项研究报道了 34 例患者（16 名男性和 18 名女性）。患者的中位年龄为 64 岁（范围 0.4-91 岁），75.8%存在肾功能不全。低血糖发作的中位持续时间为 6 天（范围 1-20 天），中位最低血糖值为 28.8mg/dL（范围 12-60mg/dL）。32 例（97.0%）患者出现神经低血糖症状，其中意识障碍（30.3%）和癫痫发作（24.2%）、出汗（18.2%）、意识混乱（15.2%）、乏力（12.1%）是最常见的症状。15 例（44.1%）患者血清胰岛素水平升高，中位数为 31.8μU/mL（范围 3-115.3μU/mL）。13 例（38.2%）患者 C 肽升高，中位数为 7.7ng/mL（范围 2.2-20ng/mL）。经干预后，88.2%的患者症状完全缓解，无后遗症。低血糖症状的持续时间为干预后 8 小时至 47 天。干预措施包括停用 TMP-SMX、静脉输注葡萄糖、胰高血糖素和奥曲肽。
低血糖是 TMP-SMX 的一种罕见且严重的不良反应。医生应意识到这种潜在的不良反应，特别是在肾功能不全、增加药物剂量和营养不良的患者中。
