UNLABELLED: Stress-related hyperinsulinism (HI) may lead to recalcitrant hypoglycemia for weeks or months following perinatal stress, often in premature newborn infants. Diazoxide is an effective and usually safe medication to treat this type and other types of neonatal HI. We report a male infant born at 35-week gestation with severe respiratory distress who developed prolonged hypoglycemia requiring high glucose infusion rates. He also had abnormal liver function tests, including hypoalbuminemia. Laboratory tests were consistent with HI, which responded to diazoxide treatment (10 mg/kg/day started at 10 days of age). The patient developed cardiorespiratory failure, hepatomegaly, worsening liver function tests, and hyperglycemia 7 weeks after the initiation of therapy. Diazoxide was discontinued with rapid resolution of the cardiorespiratory failure and without recurrence of hypoglycemia. CONCLUSION: We hypothesize that low albumin level may increase the toxicity of diazoxide, possibly by increasing the free diazoxide concentration, as this compound is typically >90% bound to plasma proteins. WHAT IS KNOWN: Diazoxide binds to plasma proteins >90% and excreted in urine. Dose adjustment is recommended in patients with impaired kidney functions. What is New: Literature is not available regarding diazoxide dose adjustment in patients with liver injury. Diazoxide toxicity is not dose-dependent.
UNLABELLED: Stress-related hyperinsulinism (HI) may lead to recalcitrant hypoglycemia for weeks or months following perinatal stress, often in premature newborn infants. Diazoxide is an effective and usually safe medication to treat this type and other types of neonatal HI. We report a male infant born at 35-week gestation with severe respiratory distress who developed prolonged hypoglycemia requiring high glucose infusion rates. He also had abnormal liver function tests, including hypoalbuminemia. Laboratory tests were consistent with HI, which responded to diazoxide treatment (10 mg/kg/day started at 10 days of age). The patient developed cardiorespiratory failure, hepatomegaly, worsening liver function tests, and hyperglycemia 7 weeks after the initiation of therapy. Diazoxide was discontinued with rapid resolution of the cardiorespiratory failure and without recurrence of hypoglycemia. CONCLUSION: We hypothesize that low albumin level may increase the toxicity of diazoxide, possibly by increasing the free diazoxide concentration, as this compound is typically >90% bound to plasma proteins. WHAT IS KNOWN: Diazoxide binds to plasma proteins >90% and excreted in urine. Dose adjustment is recommended in patients with impaired kidney functions. What is New: Literature is not available regarding diazoxide dose adjustment in patients with liver injury. Diazoxidetoxicity is not dose-dependent.
Authors: G Touati; F Poggi-Travert; H Ogier de Baulny; J Rahier; F Brunelle; C Nihoul-Fekete; P Czernichow; J M Saudubray Journal: Eur J Pediatr Date: 1998-08 Impact factor: 3.183
Authors: TingTing Huang; Andrea Kelly; Susan A Becker; Meryl S Cohen; Charles A Stanley Journal: Arch Dis Child Fetal Neonatal Ed Date: 2013-02-01 Impact factor: 5.747
Authors: Todd D Nebesio; Wynton C Hoover; Randall L Caldwell; Mara E Nitu; Erica A Eugster Journal: J Pediatr Endocrinol Metab Date: 2007-08 Impact factor: 1.634
Authors: Senthil Senniappan; Sanda Alexandrescu; Nina Tatevian; Pratik Shah; Ved Arya; Sarah Flanagan; Sian Ellard; Dyanne Rampling; Michael Ashworth; Robert E Brown; Khalid Hussain Journal: N Engl J Med Date: 2014-03-20 Impact factor: 91.245
Authors: Keyaria D Gray; Kathryn Dudash; Carla Escobar; Colman Freel; Tylah Harrison; Chandler McMillan; Mihai Puia-Dumitrescu; C Michael Cotten; Robert Benjamin; Reese H Clark; Daniel K Benjamin; Rachel G Greenberg Journal: J Perinatol Date: 2018-09-11 Impact factor: 3.225