A Novel Solution to a Case of Occult Drug-Induced Hypoglycemia

摘要

A case of sulfbnylurea-induced hypoglycemia in a non-diabetic patient is described The clinical, laboratory, and diagnostic findings in our patient are presented, and related reports in the literature are reviewed A 66-year-old, nondrabetic man was found unconscious at home Evaluation by emergency medical services revealed a finger-Stick glucose of 15 mg/dL. Investigations in the hospital, including an observed 72-hour fast, did not reveal an underlying metabolic cause of hypoglycemia Inspection of the outpatient medications revealed a bottle labeled oxybutynin Ihe alphanumeric drug code imprinted on the tablets was entered into an Internet pill identification search engine. This revealed that the patient's "oxyburynin" was actually 5-mg generic glyburide tablets A review of the literature demonstrated numerous cases of inadvertent sulfbnylurea administration. In the majority of cases, the erroneous substitution had occurred because of similarities in pill appearance, drug name spelling, or sound-alike drug names Inadvertent sulfbnylurea administration must be considered in the differential diagnosis of unexplained severe hypoglycemia Close inspection of patients' pills, with crossreierence of drug imprint codes, is critical for making the diagnosis