Hypoglycaemia associated with co-trimoxazole use in a 56-year-old Caucasian woman with renal impairment
- Resource Type
- Authors
- Ben Stone; Jody Aberdein; Donall G Forde; Anne Tunbridge
- Source
- BMJ case reports. 2012
- Subject
- Pediatrics
medicine.medical_specialty
Side effect
medicine.medical_treatment
Hypoglycemia
Asymptomatic
White People
Article
Diabetes mellitus
Trimethoprim, Sulfamethoxazole Drug Combination
medicine
Humans
Insulin
Renal Insufficiency
Intensive care medicine
Kidney transplantation
C-Peptide
business.industry
Pneumonia, Pneumocystis
General Medicine
Middle Aged
medicine.disease
Trimethoprim
Kidney Transplantation
Anti-Bacterial Agents
Pneumonia
Female
medicine.symptom
business
medicine.drug
- Language
- ISSN
- 1757-790X
Here we present a case of refractory hypoglycaemia associated with use of the antibiotic trimethoprim-sulfamethoxazole (TMP-SMX). This was used to treat Pneumocystis jirovecii pneumonia (PCP) infection. The patient had significant pre-existing renal impairment with a kidney transplant in situ. Refractory hypoglycaemia occurred 5 days after starting the antibiotic and persisted for 36 h after its cessation. SMX contains the same sulphanilamide structural group as the oral hypoglycaemic agents called sulphonureas. SMX could therefore act as an insulin secretagogue. The inappropriately raised insulin and c-peptide levels seen in our patient support this theory. The 5-day asymptomatic period would allow sufficient time for the drug to accumulate and the extended period seen after its cessation would be seen in a dose-dependent side effect. Following 3 days of observation and continuous glycaemic support on the High Dependency Unit she was discharged back to the ward, with no further occurrence of hypoglycaemia.