Glucose Intolerance During Diuretic Therapy

Améry, A; Bulpitt, Christopher J.; Schaepdryver, André De; Fagard, Robert; Hellemans, J.; Mutsers, A; Berthaux, P; Deruyttere, M; Dollery, C. T.; Forette, Françoise; Lund‐Johansen, Per; Tuomilehto, J

doi:10.1016/s0140-6736(78)90797-3

Cited by 201 publications

(21 citation statements)

References 7 publications

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“…[1][2][3][4][5] Our patient had no evidence of heart failure before diazoxide treatment and had no evidence of structural abnormality on echocardiogram when heart failure developed. Fluid intake and weight gain during diazoxide treatment of our patient on both occasions were within normal range.…”

Section: Discussionmentioning

confidence: 70%

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Cardiorespiratory Failure Secondary to Diazoxide Treatment in Nesidioblastosis: Report of a Case

Abu-Osba

Young

1988

Ann Saudi Med

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Nesidioblastosis is a rare disorder characterized by hyperinsulinemic hypoglycemia. Correction of hypoglycemia in these infants is frequently difficult despite high glucose infusion. Diazoxide, a nondiuretic benzothiadiazine, has been used in various doses to achieve euglycemia. [1][2][3][4][5] In this paper, we describe the development of cardiorespiratory failure during diazoxide treatment of one patient with nesidioblastosis. Case ReportA full-term Saudi male infant was born at an Aramco outlying clinic by spontaneous vaginal delivery. Birth weight was 4300 g. Apgar scores were 5 and 8 at 1 and 5 minutes, respectively. There was no history of maternal diabetes; the parents were first cousins. The baby was referred to Dhahran Health Center at 1 day of age because of refusal to feed and poor sucking. On admission, temperature was 36.4°C, respiratory rate 54 breaths per minute, heart rate 108 beats per minute, and blood pressure 82/38 mm Hg. Findings on physical examination, including chest, heart, and abdomen, were unremarkable with no cardiorespiratory distress. Blood glucose level on admission was 0.4 mmol/L. Despite glucose infusion up to 20 mg/kg/min, frequent episodes of hypoglycemia were observed. Glucagon injections were started after 2 days, and hydrocortisone was added 4 days after admission but was given for only 3½ days. Hypoglycemia continued to occur despite the above treatment. Hyperinsulinemia was confirmed by serum insulin levels of 122 and 309 pmol/L with simultaneous blood glucose of 1.0 and 1.2 mmol/L (insulin/glucose ratio of 122 and 257.5, respectively). At 6 days of age diazoxide was started at a dose of 17 mg/kg/day intravenously. Chlorothiazide was added as recommended in several reports (10 to 40 mg/kg/day). 1-5Hypoglycemic episodes were less frequent but not controlled, and occasional injections of glucagon and/or intravenous glucose boluses were required. After instituting the diazoxide and chlorothiazide therapy, heart and respiratory rates increased gradually. Diaphoresis, intercostal retraction, and a grade 3/6 systolic ejection murmur maximum at the left sternal border were observed. Periods of lethargy, fussiness, and irritability also were noted. Heart size, as measured by cardiothoracic ratio in chest roentgenograms, showed a steady increase (Figure 1).By 2 weeks of age, frank heart failure was evident with increased intensity of the murmur, hyperactive precordium, cardiomegaly, and hepatomegaly. Electrocardiogram showed right atrial enlargement and suggested left ventricular hypertrophy. Echocardiogram showed no structural abnormality; indices of left ventricular function were not calculated. The chest roentgenogram showed cardiomegaly and pulmonary edema, and several doses of furosemide were given. The child also became febrile, and he developed seizures. He was intubated and mechanically ventilated. Ampicillin and gentamicin were given after obtaining the appropriate cultures. Metabolic screening and the cultures were negative.Because of the continued hypoglycemic episodes, ...

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Section: Discussionmentioning

confidence: 70%

“…Diazoxide, a nondiuretic benzothiadiazine, has been used in various doses to achieve euglycemia. [1][2][3][4][5] In this paper, we describe the development of cardiorespiratory failure during diazoxide treatment of one patient with nesidioblastosis. …”

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confidence: 99%

Cardiorespiratory Failure Secondary to Diazoxide Treatment in Nesidioblastosis: Report of a Case

Abu-Osba

Young

1988

Ann Saudi Med

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“…They have been reported to be well tolerated and to lack many of the side-effects of other popular anti-hypertensive drugs, such as the biochemical disorders associated with thiazide diuretics (Amery et al, 1978;Grimm et al, 1981) or the side effects of lethargy, cold extremities, and bronchospasm following,B-adrenoceptor antagonists (Besterman, 1983). However, the information regarding tolerability of the calcium-entry blocking drugs has been derived from relatively small studies in which their blood-pressure lowering ability was the prime objective.…”

Section: Discussionmentioning

confidence: 99%

A study of the long‐term efficacy and tolerability of oral nicardipine in hypertensive patients.

Taylor¹,

Frais²,

Lee³

et al. 1985

Brit J Clinical Pharma

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1 This study was designed to evaluate the efficacy of oral nicardipine in 91 patients with uncomplicated essential hypertension over a period of 12 months. All patients started on a fixed nicardipine dose of 30 mg three times daily which was adjusted in the range 10-40 mg three times daily, where necessary to achieve a target diastolic blood pressure < 95 mm Hg. 2 At 6 weeks, blood pressure (mean + s.e. mean) was reduced from an average of 190+22/112+8 to 167+23/96+llmmHg supine and from 180+21/113+7 to 154+ 17/95+11 mm Hg standing and remained controlled in all patients throughout the study.3 A total of96 unwanted experiences were reported by 49 patients (54 % ); 17 (19 % ) reported a single symptom once and two (2% ) reported a single symptom more than once. The most frequently reported adverse experiences were peripheral oedema in 27 (28% ) and headaches in 15 patients (16%). 4 The majority of the adverse experiences occurred in the first 3 months of treatment. Ten patients (11 % ) withdrew from the study during this time and eight (9 % ) in the subsequent 9 months because of drug-related side effects; five others (5%) withdrew for unrelated reasons. 5 The incidence of adverse experiences was dose-related. Three patients reported unwanted effects on 10 mg three times daily, eight on 20 mg three times daily, 36 on 30 mg three times daily, and 12 on 40 mg three times daily oral nicardipine. 6 The relatively high incidence ofreported adverse experiences may reflect the fact that there was no comparative placebo control group and that patients were encouraged to report all adverse experiences.

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“…It has been demonstrated in a preliminary report from this group that blood pressure can be significantly reduced with drug treatment 132 . The expected unwanted effects of thiazides in this age group are seenglucose intolerance 133 and raised serum urate and creatinine 132 -but an overall significant reduction of blood pressure is possible with acceptable levels of unwanted effects. Reserpine causes mental depression and methyldopa produces lassitude, drowsiness and decrease in mental acuity far more prominently in the elderly134.135.…”

Section: Antihypertensive Drugsmentioning

confidence: 99%