WUTH publication: Severe co-trimoxazole-induced hypoglycaemia in a patient with microscopic polyangiitis

Citation: BMJ Case Reports. 2017 Mar 16
Author: Conley TE, Mohiuddin A, Naz N
Abstract: A 69-year-old man presented to the emergency department with lower respiratory tract infection and febrile neutropaenia. He was recently discharged following a 50-day hospital stay with newly diagnosed microscopic polyangiitis, complicated by pulmonary haemorrhage and severe renal dysfunction requiring renal replacement therapy, plasma exchange and immunosuppression (cyclophosphamide and methylprednisolone). High risk of pneumocystis pneumonia (PCP) led to an escalation in treatment from prophylactic to therapeutic oral co-trimoxazole, alongside broad-spectrum antibiotics. The patient suffered from severe and protracted hypoglycaemia, complicated by a tonic-clonic seizure 7 days after escalation to therapeutic co-trimoxazole. Endogenous hyperinsulinaemia was confirmed and was attributed to co-trimoxazole use. Hypoglycaemia resolved 48 hours after discontinuation of co-trimoxazole. PCP testing on bronchoalveolar lavage was negative. Owing to the prescription of heavy immunosuppression in patients with vasculitis and the subsequent risk of PCP warranting co-trimoxazole prophylaxis, we believe that the risk of hypoglycaemia should be highlighted.

Link to PubMed record

Today’s QI Network meeting at 11:30 in Maternity Conference Room has been cancelled.

Unfortunately due to the problems at Lime Street Station the presenter is unable to attend and the activation of the full capacity policy it has been decided to cancel this meeting. 

WUTH Library and Knowledge Service (LKS) featured in national library campaign!

Earlier this year the ‘A Million Decisions campaign’  which demonstrated the impact NHS Library Services have on clinical and non-clinical decisions made each year in the NHS was launched by the Chartered Institute for Library and Information Professionals (CILIP).

The work that WUTH Library and Knowledge Service has undertaken with both the WUTH Critical Care unit and with the Microbiology department has been showcased as examples of how the partnership between the LKS and clinical colleagues has impacted on patient care, decision making and service improvement.

Has the WUTH LKS had an impact on your service or practice? 

If so please:

·       Submit a case study to the Knowledge for Healthcare website at http://kfh.libraryservices.nhs.uk/share-your-impact-case-studies

·       Tweet or post on Facebook using the #amilliondecisions hashtag

For more details visit the CILIP website at http:// www.cilip.org.uk/amilliondecisions or ask a member of the Library team.