Tigecycline-induced sustaining and severe hypoglycemia: a case report

We describe a case of sustaining and severe hypoglycemia in a patient treated with tigecycline for pneumonia infected with MDR klebsiella. 50% glucose supplement through femoral vein was required for over 20 hours to maintain the blood glucose. The first episode occurred about 37 hours after the initial use of tigecycline. The hypoglycemic course did not cease until 34 hours after the final therapy of tigecycline. The insulin and C-peptide levels were dramatically elevated when the hypoglycemia happened. The Naranjo scale scoring 7 indicated that the likelihood of tigecycline causing severe hypoglycemia was “probable”. This is the first sustaining and severe hypoglycemic event reported due to tigecycline. Over-processed insulin was the leading cause of the hypoglycemic event.

本病例报告了1例接受替加环素（tigecycline）治疗多重耐药克雷伯菌（MDR Klebsiella）肺炎的患者发生持续性重度低血糖的案例。需通过股静脉输注50%葡萄糖注射液长达20余小时以维持血糖稳态。首次低血糖发作于首次使用替加环素后约37小时，该低血糖状态直至末次替加环素治疗后34小时才得以终止。低血糖发作时，患者的胰岛素（insulin）及C肽（C-peptide）水平显著升高。采用Naranjo不良反应概率量表（Naranjo Scale）评分为7分，提示替加环素引发重度低血糖的可能性为“很可能”。这是首篇报道由替加环素引发的持续性重度低血糖事件的病例报告。外源性过量胰岛素（over-processed insulin）为该低血糖事件的主要诱因。