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Severe hypoglycemic seizures in a child receiving 6-mercaptopurine

Mohamad K El-Bitar1, Samar A Muwakkit, Omar Dabbagh

  • 1Division of Pediatric Neurology, Department of Pediatrics and Adolescent Medicine, Childrens' Cancer Center of Lebanon, American University of Beirut Medical Center, Beirut, Lebanon.

Journal of Pediatric Hematology/Oncology
|February 24, 2011
PubMed

Insights

Severe hypoglycemia and prolonged seizures in a child with acute lymphoblastic leukemia were linked to 6-mercaptopurine maintenance chemotherapy. Fasting exacerbated this adverse drug reaction, highlighting a critical drug-food interaction.

Area of Science:

  • Pediatric Oncology
  • Pharmacology
  • Neurology

Background:

  • Acute lymphoblastic leukemia (ALL) treatment often involves maintenance chemotherapy.
  • 6-Mercaptopurine (6-MP) is a common agent used in ALL maintenance therapy.
  • Hypoglycemia is a potential, though less common, adverse effect of 6-MP.

Observation:

  • A 4-year-old boy undergoing ALL maintenance chemotherapy with 6-MP experienced prolonged generalized tonic-clonic seizures.
  • The seizures occurred following a 12-hour fasting period after his evening dose of 6-MP.
  • Severe hypoglycemia was identified as the direct cause of the seizures.

Findings:

  • Investigations excluded other potential causes for the seizures and hypoglycemia.
  • The clinical presentation strongly implicated 6-mercaptopurine as the cause of severe hypoglycemia.
  • The interaction between 6-MP and fasting precipitated the adverse event.

Implications:

  • This case highlights a critical drug-food interaction between 6-mercaptopurine and fasting.
  • Awareness of this interaction is crucial for managing pediatric patients on 6-MP maintenance therapy.
  • Close monitoring for hypoglycemia is recommended, especially during periods of fasting or reduced oral intake.

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