恶病质艾滋病患者甲氟喹相关性低血糖。

Diabete & metabolisme Pub Date : 1995-02-01
R Assan, C Perronne, L Chotard, E Larger, J L Vilde
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引用次数: 0

摘要

由于胰岛素分泌过多,奎宁及其异构体奎尼丁是众所周知的医源性低血糖的原因。其他抗疟疾奎宁类似物的情况不太清楚。特别是,甲氟喹(Lariam)从未描述过这种不良反应。我们报告一例低血糖后甲氟喹治疗(1500毫克超过两天)严重胃肠道隐孢子虫病的艾滋病患者长期腹泻的恶病质。治疗前血糖正常,几小时内降至2.3 mmol/l,经静脉滴注葡萄糖纠正。尽管持续治疗,低血糖没有复发。体外暴露于甲氟喹(10(-8)mol/l至10(-3)mol/l)的朗格hans大鼠胰岛分泌的胰岛素明显高于对照组(甲氟喹10(-3)mol/l培养的胰岛高达980 +/- 180 microU/ml/5,而未处理的胰岛为20 +/- 4 microU/ml/5)。本文讨论了甲氟喹和其他抗疟疾奎宁类似物致低血糖的机制和触发因素。治疗恶病质患者的临床医生,特别是那些长期腹泻和/或接受包括甲氟喹在内的抗疟疾药物治疗的患者,应该意识到严重低血糖的风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Mefloquine-associated hypoglycaemia in a cachectic AIDS patient.

Quinine and its isomer quinidine are well-known causes of iatrogenic hypoglycaemia, due to excessive insulin secretion. The situation is less clear regarding other anti-malarial quinine analogues. In particular, this adverse effect has never been described with mefloquine (Lariam). We report a case of hypoglycaemia after mefloquine therapy (1,500 mg over two days) for severe gastrointestinal cryptosporidiasis in a cachectic AIDS patient with protracted diarrhoea. Blood glucose levels, which were normal before treatment, dropped to 2.3 mmol/l within a few hours and were corrected by i.v. glucose infusion. Hypoglycaemia did not recur despite continued treatment. Rat islets of Langerhans exposed to mefloquine in vitro (10(-8) mol/l to 10(-3) mol/l) secreted significantly more insulin than control islets (up to 980 +/- 180 microU/ml/5 islets incubated with mefloquine 10(-3) mol/l, vs 20 +/- 4 microU/ml/5 untreated islets). Mechanisms and triggering factors of hypoglycaemia induced by mefloquine and some other anti-malarial quinine analogues are discussed. Clinicians who manage cachectic patients, particularly those with protracted diarrhoea and/or receiving anti-malarial drugs including mefloquine, should be aware of the risk of severe hypoglycaemia.

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