• Title, Summary, Keyword: Hypoglycemia

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Severe recurrent nocturnal hypoglycemia during chemotherapy with 6-mercaptopurine in a child with acute lymphoblastic leukemia

  • Cho, Eun Mi;Moon, Jung Eun;Lee, Soo Jung;Ko, Cheol Woo
    • Annals of Pediatric Endocrinology and Metabolism
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    • v.23 no.4
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    • pp.226-228
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    • 2018
  • Various endocrine dysfunctions occur during chemotherapy, including hypoglycemia. However, reports of hypoglycemia associated with 6-mercaptopurine (6-MP) are rare. Herein, we report an 8-year-old boy with severe symptomatic hypoglycemia likely due to 6-MP during chemotherapy. He had been diagnosed with acute lymphoblastic leukemia 3 years previously and was in the maintenance chemotherapy period. Treatment included oral dexamethasone, methotrexate, and 6-MP, of which only 6-MP was administered daily. Hypoglycemic symptoms appeared mainly at dawn, and his serum glucose dropped to a minimum of 37 mg/dL. Laboratory findings showed nothing specific other than increased serum cortisol, free fatty acids, ketone, alanine aminotransferase, and aspartate aminotransferase. Under the hypothesis of hypoglycemia due to chemotherapy drugs, we changed the time of 6-MP from evening to morning and recommended him to ingest carbohydrate-rich foods before bedtime. Hypoglycemia improved dramatically, and there was no further episode during the remaining maintenance chemotherapy period. To the best of our knowledge, this is the first report of this type of hypoglycemia occurring in an Asian child including Korean.

Cardiac Arrest in Conjunction with Hypoglycemia in a Non-Diabetic Patient with Cerebral Infarction (당뇨병이 없는 뇌경색 환자에서 발생한 저혈당과 동반된 심정지)

  • Ko, Jeongmin;Lee, Ji-Yong
    • Journal of Neurocritical Care
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    • v.11 no.2
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    • pp.143-147
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    • 2018
  • Background: Hypoglycemia is uncommon in people without diabetes. There have been only a few reports of cardiac arrest in conjunction with hypoglycemia in non-diabetic patients. Case Report: A 66-year-old man visited the emergency room with dizziness. He was a chronic alcoholic. Laboratory test showed no evidence of diabetes mellitus. Brain magnetic resonance imaging revealed a left cerebellar infarction. Abdomen computed tomography demonstrated liver cirrhosis with minimal ascites. During his hospital stay, he consumed only a small amount of food because of nausea and headache. On hospital day 4, he had a cardiac arrest after two seizure episodes. His blood glucose was 10 mg/dL. The combination of liver cirrhosis, renal failure and poor oral intake was presumed to be the causes of the severe hypoglycemia. Conclusion: We report a rare case of cardiac arrest occurring in conjunction with severe hypoglycemia in a non-diabetic patient with cerebral infarction.

Localized Pleural Mesothelioma Inducing Hypoglycemia - 1 case report - (저혈당증을 동반한 늑막 중피세포종 -1례 보고-)

  • 홍유선
    • The Korean Journal of Thoracic and Cardiovascular Surgery
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    • v.21 no.3
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    • pp.558-562
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    • 1988
  • Localized mesothelioma is a primary pleural tumor that induces hypoglycemia rarely. We experienced a case of the localized mesothelioma that induced hypoglycemia. The patient was 70 year-old man who was admitted to Severance Hospital because of general weakness and mental confusion in morning before breakfast. He was found to have low level of fasting blood sugar and C-peptide, but had normal serum insulin level. After excision of the tumor, the patient was free from symptoms of hypoglycemia, and fasting blood sugar level was returned to normal range. The most likely speculation of causing hypoglycemia by the mesothelioma was thought to be that the tumor did not secrete insulin itself but the undetectable insulin-like substance and/or antigluconeogenic substances. During the follow up, 5 months after surgical removal of tumor, the patient was in a good condition without symptoms of hypoglycemia.

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DENTAL TREATMENT OF A PATIENT WITH PERSISTENT HYPERINSULINEMIC HYPOGL YCEMIA OF INFANCY UNDER GENERAL ANESTHESIA - A CASE REPORT - (지속 고인슐린성 저혈당증 환자의 전신마취 하 치과치료 - 증례보고 -)

  • Jeon, Myong-Sook;Seo, Kwang-Suk;Kim, Hyun-Jeong;Yum, Kwang-Won;Yi, Young-Eun
    • The Journal of Korea Assosiation for Disability and Oral Health
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    • v.3 no.1
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    • pp.22-25
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    • 2007
  • Persistent hyperinsulinemic hypoglycemia of infancy (PHHI) characterized by severe hypoglycemia caused by inappropriate over secretion of insulin is the most common cause of hypoglycemia in early infancy. The symptoms of hypoglycemia in neonate and infancy are neonatal sepsis, respiratory difficulty, tachypnea, apnea, cyanosis, and seizure. Especially the recurrent and severe hypoglycemia within $1^{st}$ year of life is responsible for severe and irreversible brain damage. To prevent it aggressive treatment is required. Due to severe and irreversible brain damage these children frequently require anesthesia during imaging procedures such as MRI or during various dental surgical procedures. Because of frequent hypoglycemia and dental phobia in children with neurologic disorder, anesthesiologists should pay attention to patient. We report a successful anesthetic management in a patient with PHHI for dental procedures.

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Glucose metabolism and evaluation of hypoglycemia in neonates (신생아에서의 포도당 대사와 저혈당증의 평가)

  • Kim, Eun Young
    • Korean Journal of Pediatrics
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    • v.50 no.3
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    • pp.223-229
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    • 2007
  • The fetus is completely dependent on mother for glucose and other nutrient transfer across the placenta. At birth, when the maternal supply is discontinued, the neonate must adjust to an independent existence. The changes in the neonate's glucose homeostasis during this transition to the extrauterine environment are influenced by the mother's metabolism and intrinsic fetal and placental problems. Maturation of carbohydrate homeostasis results from a balance between substrate availability and coordination of developing hormonal, enzymatic, and neural systems. These mechanisms may not be fully developed in neonates, so the neonate is vulnerable to carbohydrate disequilibrium resulting in damage to the central nervous system. Hypoglycemia is a relatively common metabolic problem seen during newborn care. However its definition, management and long term sequalae remain controversial. Hyporglycemia occurs frequently as a transient disorder with excellent prognosis. It also may persist and recur and cause permanent neurological complications. Although the key to effective treatment of hypoglycemia is diagnostic specific, the maintenance of euglycemia is critical to the preservation of central nervous system function. This article discusses physiology of perinatal glucose homeostasis, focusing on evaluation and treatment of hypoglycemia.

Anti-Depressant Like Effect of Methyl Gallate Isolated from Acer barbinerve in Mice

  • Lee, Jin-Koo
    • The Korean Journal of Physiology and Pharmacology
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    • v.17 no.5
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    • pp.441-446
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    • 2013
  • In the present study, the anti-depressant like effect of methyl gallate (MG) isolated from the stem bark of Acer barbinerve was examined in ICR mice. Body weight (BDW) and blood glucose (BDG) levels significantly decreased in the repeated restraint stress (RRS) group (2 h/day for 14 days) compared to the no stress (NS) group. To examine the effect of MG on RS-induced BDW loss and hypoglycemia, MG (10 mg/kg) and the anti-depressant fluoxetine (10 mg/kg) were administered daily for 14 days. Orally administered MG and fluoxetine significantly attenuated the RS-induced BDW loss and hypoglycemia. Interestingly, MG administered mice showed increased BDG levels in the normal and glucose feeding condition. Chronic RS-subjected mice showed immobilized and depressed behaviors. The effect of MG on the depressed behaviors was evaluated using the tail-suspension test (TST) and the forced swimming test (FST). In both tests, RS-induced immobilized behaviors were significantly reversed in MG and fluoxetine administered groups. Taken together, MG significantly attenuated the RS-induced BDW loss, hypoglycemia, and depressed behaviors. Considering that decreased BDG levels (hypoglycemia) can cause depression, MG may exert its anti-depressant like effect by preventing hypoglycemia. Our results suggest that MG isolated from A. barbinerve can exert anti-depressant like effect, and could be used as a new and natural anti-depressant therapy.

Treatment of Hemangiopericytoma-Associated Hypoglycemia with Glucocorticoid Therapy (전이성 혈관주위세포종 환자에서 발생한 저혈당을 프레드니솔론으로 치료한 1예)

  • Park, Sung-Woo;Kim, Dong-Geun;Kim, Myung-Jin;Jang, Hyo-Jin;Sohn, Se-Hoon;Koh, Sung-Ae;Lee, Ha-Young;Kim, Min-Kyoung;Lee, Kyoung-Hee;Hyun, Myung-Soo
    • Yeungnam University Journal of Medicine
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    • v.28 no.1
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    • pp.77-83
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    • 2011
  • Non-islet cell tumor-induced hypoglycemia (NICTH) is associated with mesenchymal tumor types, including hemangiopericytoma, fibrosarcoma, mesothelioma, and neurofibroma, as well as carcinoma of the liver, adrenal glands, and kidneys. Non- islet cell tumors induce hypoglycemia by overproducing an abnormal form of insulin-like growth factor II (IGF m. Complete removal of the tumor or reduction of the tumor mass is a successful therapeutic strategy in cases of NICTH. However, if the tumor re-grows, curative resection is nearly impossible, and hypoglycemia occurs repeatedly. Glucocorticoids are effective in terms of long-term relief from hypoglycemia through promotion of gluconeogenesis in the liver, tumor suppression, production of 'big'-IGF-II, and correction of the attendant biochemical abnormalities involving the growth hormone (GH)-IGF axis. We found that administration of corticosteroid therapy to a patient suffering from NICTH resulted in improvement of hypoglycemia associated symptoms.

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Prehospital Treatments of the Patient with Hypoglycemia by 119 Emergency Medical Technicians - Analysis of the Current Data and Survey - (119구급대원의 저혈당 환자에 대한 병원 전 응급처치현황과 개선방안)

  • Ahn, Hee-Jeong
    • The Korean Journal of Emergency Medical Services
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    • v.14 no.1
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    • pp.31-46
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    • 2010
  • This study was intended to analyze the clinical characteristic of the patient with hypoglycemia and the status of prehospital treatments by 119 emergency medical technicians well as the cause of inappropriate emergency treatment by 119 emergency medical technicians in a bid to seek the measures for improvement, thereby enhancing the emergency medical services before medical treatment at hospital. Examination of the daily work log on 430 patients suffering with hypoglycemia who were sent to the university hospital in Gyunggi-Province by 119 emergency medical technicians, beginning on Jan 1, 2004 till Dec 31. 2008 was carried out and the survey of 206 119 emergency medical technicians working at the region of Gyunggid-Province was conducted from Sep 19 through Oct 6, 2009. Evaluation of the frequency and percentage and ANOVA analysis using SPSS WIN 14.0 program was carried out. In view of the examination of daily emergency work log and questionnaire, prehospital treatment for the patients with hypoglycemia needs to be further improved in general, and to provide the emergency treatment in accurate and timely manner, improvement of the system such as assignment of licensed rescue members and development of protocol that will replace the medical consultant system, mandatory emergency treatment, constant and efficient training and maintenance of emergency rescue records shall be implemented, and furthermore, social recognition to 119 emergency medical technicians shall be improved to encourage them to perform more positive way and manner.

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A novel mutation of ABCC8 gene in a patient with diazoxide-unresponsive congenital hyperinsulinism

  • Park, Ji Sook;Lee, Hong-Jun;Park, Chan-Hoo
    • Korean Journal of Pediatrics
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    • v.59 no.sup1
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    • pp.116-120
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    • 2016
  • Congenital hyperinsulinism (CHI) is a rare condition that can cause irreversible brain damage during the neonatal period owing to the associated hypoglycemia. Hypoglycemia in CHI occurs secondary to the dysregulation of insulin secretion. CHI has been established as a genetic disorder of islet-cell hyperplasia, associated with a mutation of the ABCC8 or KCNJ11 genes, which encode the sulfonylurea receptor 1 and the inward rectifying potassium channel (Kir6.2) subunit of the ATP-sensitive potassium channel, respectively. We report the case of a female newborn infant who presented with repetitive seizures and episodes of apnea after birth, because of hypoglycemia. Investigations revealed hypoglycemia with hyperinsulinemia, but no ketone bodies, and a low level of free fatty acids. High dose glucose infusion, enteral feeding, and medications could not maintain the patient's serum glucose level. Genetic testing revealed a new variation of ABCC8 mutation. Therefore, we report this case of CHI caused by a novel mutation of ABCC8 in a half-Korean newborn infant with diazoxide-unresponsive hyperinsulinemic hypoglycemia.

Concurrent Use of Sulfonylureas and Antimicrobials of the Elderly in Korea: A Potential Risk of Hypoglycemia (고령자에서 Sulfonylureas와 항균제의 병용투여 현황)

  • Lee, Sera;Ock, Miyoung;Kim, Hyunah
    • Korean Journal of Clinical Pharmacy
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    • v.28 no.3
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    • pp.188-193
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    • 2018
  • Background: Previous studies have noted that the simultaneous use of sulfonylureas and antimicrobials, which is common, could increase the risk of hypoglycemia. In particular, an age of 65 years or older is a known risk factor for sulfonylurea-related hypoglycemia in hospitalized patients. Therefore, we performed this study to determine the potential risk of hypoglycemia from the concurrent use of antimicrobials and sulfonylureas. Methods: We performed a cross-sectional study on the National Health Insurance Service-National Sample Cohort from 2013. The eligibility criteria included patients of 65 years of age or older taking a sulfonylurea with 25 different antimicrobials. Different risk ratings of severity in drug-drug interactions (potential DDIs), level X, D, or C in Lexi-$Interact^{TM}$ online, and contraindicated, major, or moderate severity level in $Micromedex^{(R)}$ were included. SAS version 9.4 was used for data analysis. Results: A total of 6,006 elderly patients with 25,613 prescriptions were included. The largest age group was 70 to 74 (32.7%), and 39.7% of patients were men. The mean number of prescriptions was 4.3 per patient. The most frequently used antimicrobials were levofloxacin (6,583, 25.7%), ofloxacin (6,549, 25.6%), fluconazole (4,678, 18.0%), and ciprofloxacin (2,551, 9.8%). Among sulfonylureas, glimepiride was prescribed most frequently, followed by gliclazide, glibenclamide, and glipizide. Conclusion: Of the antimicrobials with a high potential of hypoglycemia, levofloxacin, ofloxacin, fluconazole, and ciprofloxacin were used frequently. Thus, the monitoring of clinically relevant interactions is required for patients concurrently administered sulfonylureas and antimicrobials.