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Published on: August 30, 2018
Life-threatening metabolic coma caused by levofloxacin
Nidhi Bansal1, Divey Manocha, Bhaskar Madhira
11Departments of Internal Medicine and 2Gastroenterology, SUNY Upstate Medical University, Syracuse, NY.
American Journal of Therapeutics
|July 31, 2013
Summary
Hypoglycemia can occur in diabetes patients. A case study suggests levofloxacin may cause severe hypoglycemia, even in patients on metformin monotherapy, necessitating careful medication review.
Area of Science:
- Endocrinology
- Pharmacology
- Internal Medicine
Background:
- Diabetes mellitus patients are prone to hypoglycemia, often due to medication, diet, or illness.
- Unexplained hypoglycemia warrants a thorough review of all concomitant medications.
Observation:
- A 56-year-old female on metformin monotherapy presented with severe hypoglycemia (15 mg/dL) after starting levofloxacin for pneumonia.
- Despite normal initial investigations, hypoglycemia recurred, requiring intensive care, dextrose, and glucagon.
- Elevated insulin, IGF-1, and C-peptide levels were noted but were nondiagnostic due to fluctuating glucose.
Findings:
- Levofloxacin was identified as the probable cause of recurrent hypoglycemia after excluding other common etiologies.
- The patient's renal insufficiency (creatinine clearance 42 mL/min) may have contributed to altered drug metabolism.
Implications:
- This case highlights a potential drug-induced hypoglycemia risk with levofloxacin, especially in patients with renal impairment.
- Clinicians should consider fluoroquinolones like levofloxacin as a potential cause of unexplained hypoglycemia.
- Careful medication reconciliation is crucial for managing hypoglycemia in diabetic patients.
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