Management of hyperinsulinemia with diazoxide in an elderly hemodialysis patient

An elderly, nondiabetic, chronic hemodialysis patient is described here who had profound hypoglycemia for a myriad of reasons including renal failure, malnutrition, and quinine use. Furthermore, by biochemical parameters the patient had hyperinsulinemia, which was consistent with the diagnosis of an insulinoma. However, a tumor was not identified by noninvasive radiologic imaging as is often the case and the patient was not a candidate for surgical exploration. Diazoxide at a dose of 225 mg/day was used to successfully manage this patient's hypoglycemia. Previous experience with the use of diazoxide for hyperinsulinism in the hemodialysis population is limited and this case is the second report of its use for this purpose.