Reactions 1327 - 13 Nov 2010

SGlipizide/octreotide

Hypoglycaemia and hyperkalaemia: case reportA 48-year-old man developed hypoglycaemia during

glipizide treatment. He subsequently developed severehyperkalaemia following treatment with octreotide for hishypoglycaemia.

The man, who was on haemodialysis and had type 2diabetes mellitus, had been receiving glipizide [route,dosage and duration of therapy to reaction onset notstated], folic acid, allopurinol, warfarin, atenolol,esomeprazole, amiodarone, calcitriol, sevelamer and multi-vitamin tablets. He presented with constant substernalchest pain and palpitations. On examination, he wascachectic but alert. Tests revealed a blood glucose level of37 mg/dL. He was diagnosed with symptomatichypoglycaemia and volume overload.

Glipizide was discontinued, and the man receivedglucose. Haemodialysis was started. Despite multipleampules of glucose, he had persistent hypoglycaemia. Hewas transferred to the ICU. He received a continuousinfusion of glucose for 8h and started receiving SCoctreotide 50µg every 6h. After three doses of octreotide,his potassium level was 7.3 mEq/L. He received salbutamol[albuterol], glucose, calcium gluconate, insulin and sodiumpolystyrene sulfonate and his potassium level decreased to6.7 mEq/L. He underwent dialysis and octreotide wasdiscontinued. His potassium level normalised and hiscondition improved.

Author comment: "Octreotide-associated hyperkalaemia ismost likely due to the suppression of insulin release, whichimpairs cellular potassium uptake resulting in an increasedextracellular potassium concentration."Adabala M, et al. Severe hyperkalaemia resulting from octreotide use in ahaemodialysis patient. Nephrology Dialysis Transplantation 25: 3439-3442, No.10, Oct 2010. Available from: URL: http://dx.doi.org/10.1093/ndt/gfq381 -USA 803043559

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Reactions 13 Nov 2010 No. 13270114-9954/10/1327-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved