Metronidazole Induced Hypoglycemia on an Elderly Patient without Diabetes

Abstract

In the elderly, diabetes patients often experienced hypoglycemia due to medication. However, hypoglycemia can occur in awide variety of situations without diabetes such as these cases including heavy alcohol drinking, decreased liver function,sepsis, pneumonia, and decreased renal function, etc. In this case, hypoglycemia occurred in treating with cefotaxime andmetronidazole in patients with abdominal pain due to intravascular embolism at the entrance of the superior mesenteric artery.This hypoglycemia was accompanied by hyperinsulinemia. The possibility of other adrenal insufficiency was excluded becauseof normal response in rapid ACTH test. Insulinoma was also excluded because of no experience of hypoglycemia beforeadmission and no tumor in pancreas in CT scan. In addition, renal function was recovering, so renal function was unlikely to bea cause.We doubt the possibility of antimicrobial agents,cefotaxime and metronidazole, as a cause of hypoglycemia. Firstly, westopped cefotaxime, but continued hypoglycemia until day 3. And, as the next step, we quit the use of metronidazole and thenhypoglycemia was recovered. In this case, we suggested that hypoglycemia was related with metronidazole. Hypoglycemiaassociated with metronidazole is mainly associated with the use of diabetes medications in previous cases, and few cases ofhypoglycemia in patients without such diabetes have been reported. Therefore, we report hypoglycemia associated with the useof metronidazole in elderly patients without diabetes.