Hypoglycemic coma

Sulfonylureas. The hypoglycemic effect of sulfonylureas was first noted in the early 1940s when several patients died in hypoglycemic coma after testing glyprothia2ole, a synthetic sulfonamide used to treat typhoid. Chemical modifications which enhanced activity and lowered toxicity led to the development of the first-generation sulfonylureas. Carbutamide [339-43-5] the first commercial sulfonylurea, came onto the European... 

Usual dose schedules of streptozotocin involve 500 mg/m2 i.v. during five consecutive days. The major toxicity is renal tubular damage. Treatment of metastatic insulinomas may result in the release of insulin from the tumor and subsequent hypoglycemic coma. Less severe toxicities include diarrhea, anemia, and mild alterations in glucose tolerance or liver function tests. 

Blood glucose levels in patients with von Gierke disease fall precipitously upon fasting, such as occurs overnight during sleep, so treatment is to eat meals often to prevent hypoglycemic coma. 

Biguanides cause hypoglycemia in 0.24 cases per 100 patient-years and it is more common when they are used in combination with a sulfonylurea (44). In 102 consecutive patients with drug-induced hospital-related hypoglycemic coma, 13 were taking metformin + glibenclamide and 3 were taking metformin + insulin (45). 

Ben-Ami H, Nagachandran P, Mendelson A, Edoute Y. Drug-induced hypoglycemic coma in 102 diabetic patients. Arch Intern Med 1999 159(3) 281-4. 

Hypoglycemic coma due to insulin with extensive mental changes has been reported, including a review of six comparable cases in patients aged 37-56 years, whose coma lasted from 36 hours to 31 days (73). 

Of 20 patients with severe hypoglycemic coma and 20 with no or light coma, those with hypoglycemia had chronic depression and anxiety and performed persistently more poorly in several cognitive tests (74). 

Berger A, Croisier M, Jacot E, Kehtari R. Coma hypo-glycemique de longue duree. [Hypoglycemic coma of long duration.] Rev Med Suisse Romande 1999 119(l) 49-53. 

Frequent attacks of hypoglycemia can result in encephalopathy, and after withdrawal of the hypoglycemic drug cerebral injury can persist. It is not exceptional for prolonged hypoglycemic coma to end fatally (43,44). In 494 cases of severe hypoglycemia, 10% of the patients died and 9% had permanent sequelae (45). 

Gill MJ, Ratliff DA, Harding LK. Hypoglycemic coma, jaundice, and pure RBC aplasia following chlorpropamide therapy. Arch Intern Med 1980 140(5) 714-5. 

Momordica charantia can cause hypoglycemic coma and convulsions in children (316). 

Lindvall, O., Ernfors, P., Bengzon,J., Kokaia, Z., Smith, M. L., Siesjo, B. K., and Persson, H. (1992). Differential regulation of mRNAs for nerve growth factor, brain-derived neurotrophic factor, and neurotrophin 3 in the adult rat brain following cerebral ischemia and hypoglycemic coma. Proc. Natl Acad. Sci USA 89, 648-652. 

We also measured plasma B, concentrations in nine diabetic patients admitted as emergencies with hypoglycemic comas of 0.7 to 8 hr duration. Four of the nine diabetics had elevated B, upon admission but the abnormalities were relatively minor, with mean levels being 4.7 0.9 pg/liter (reference range, 1.2-4.0 pg/liter). 

Phenacetin has analgesic and antipyretic but no antiinflammatory properties. Phenacetin and its deethylated metabolite, acetaminophen, are superior to aspirin in that they do not cause hypoprothrombinemia, GI irritation, or disturbances of acid-base balance. The serious, but rare, side effects of phenacetin are methemoglobinemia, hemolytic anemia, fatal hepatic necrosis, and hypoglycemic coma. Both interstitial nephritis and renal papillary necrosis can be caused by phenacetin and acetaminophen. The less toxic acetaminophen should be used only in patients who cannot tolerate aspirin or in whom aspirin is contraindicated (see also Table 3). 

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