Reactions 1180 - 1 Dec 2007

★ SOctreotide

Hyperglycaemia (first report) and bradycardia in aninfant: case report

A 3-month-old male infant developed hyperglycaemia andbradycardia while receiving octreotide.

The infant, who had congenital hyperinsulinaemia, wasscheduled for pancreatectomy. He presented with episodichypoglycaemia that was managed with a 10% glucose infusion.Because of diazoxide unresponsiveness, he received SCoctreotide 0.5µg every 6 hours [duration of treatment notstated]. His preoperative blood glucose level was2.2–2.7 mmol/L. Immediately after induction of anaesthesia,his blood glucose level was 5.8 mmol/L and, 15 minutes later,it was 19 mmol/L.

The infant started receiving soluble insulin at an increasingdose. Twenty minutes after anaesthetic induction, his HRdecreased to 35 beats/min and his BP decreased to 80mm Hg.He received IV atropine and his HR increased to124 beats/min. He received maintenance fluids. Subsequentblood glucose readings were consistently high. His insulindosage was increased by 10 times, without improvement. Hisurine output was about 5 mL/kg/h; this was thought to besecondary to osmotic diuresis. Arterial blood gas analysisrevealed a pH of 7.19. After surgery, he was transferred to thepostanaesthesia care unit. The insulin infusion was tapered ashis blood glucose normalised. He received no furtheroctreotide. The rest of his hospitalisation was uneventful.

Author comment: "The cause for this adverse event wasthought to be unpredictable effects of octreotide."Batra YK, et al. Octreotide-induced severe paradoxical hyperglycemia andbradycardia during subtotal pancreatectomy for congenital hyperinsulinism in aninfant. Pediatric Anesthesia 17 (Suppl. S): 1117-1119, No. 11, Nov 2007 -India 801097684

» Editorial comment: A search of AdisBase and Medline didnot reveal any previous case reports of hyperglycaemiaassociated with octreotide. The WHO Adverse Drug Reactionsdatabase contained 19 reports of hyperglycaemia associatedwith octreotide.

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Reactions 1 Dec 2007 No. 11800114-9954/10/1180-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved