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Liver injury may increase the risk of diazoxide toxicity: a case report

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Abstract

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.

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Abbreviations

AFP:

Alpha-feta protein

BWS:

Beckwith-Wiedemann Syndrome

GIR:

Glucose infusion rate

HCM:

Hypertrophic cardiomyopathy

HI:

Hyperinsulinism

PGE1:

Prostaglandin E1

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Acknowledgments

No funding applicable for this case report.

Authors’ contributions

All authors took part in the clinical care of the subject and in the writing of the manuscript. All authors read and approved the final manuscript.

Consent

Written informed consent was obtained from the patient for publication of this case report. A copy of the written consent is available for review by the Editor-in-Chief of this journal.

Conflict of interest

Authors do not have any competing or conflicts of interests.

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Authors and Affiliations

  1. Division of Pediatric Endocrinology and Diabetes, Children’s Hospital of Pittsburgh, 4401 Penn Ave, Pittsburgh, PA, 15224, USA

    Emir Tas, Luigi Garibaldi & Mark Sperling

  2. Division of Neonatal Intensive Care Unit, Children’s Hospital of Pittsburgh, 4401 Penn Ave, Pittsburgh, PA, 15224, USA

    Burhanuddin Mahmood

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  1. Emir Tas
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  2. Burhanuddin Mahmood
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  3. Luigi Garibaldi
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  4. Mark Sperling
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Corresponding author

Correspondence to Emir Tas.

Additional information

Communicated by Beat Steinmann

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Tas, E., Mahmood, B., Garibaldi, L. et al. Liver injury may increase the risk of diazoxide toxicity: a case report. Eur J Pediatr 174, 403–406 (2015). https://doi.org/10.1007/s00431-015-2488-6

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  • DOI: https://doi.org/10.1007/s00431-015-2488-6

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