Drug Induced Hypoglycaemia – New Insights into an Old Problem

Hypoglycaemia is a common, potentially fatal, yet preventable problem. The aetiology of hypoglycaemia is variable, but druginduced hypoglycaemia remains the commonest cause. Determining the aetiology of hypoglycaemia poses little difficulty in patients known to be taking oral hypoglycaemic agents (OHAs). However, it becomes a challenge in those without a history of such exposure. The Hospital Authority Toxicology Reference Laboratory (TRL) received 51 referrals for suspected drug-induced hypoglycaemia in patients without a history of current hypoglycaemic agent use in the period between June 2005 and March 2006. In 23 (45%) of these patients, OHAs and/or their metabolites were detected by toxicology screening. The causative OHAs were found to be gliclazide and glibenclamide in 14 and 8 patients, respectively. For the remaining patients, glimepiride, nateglinide and rosiglitazone were detected. The possible sources of OHAs deduced on the basis of available clinical information are shown in Table 1.