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BMC Endocrine Disorders
Published in: BMC Endocrine Disorders 1/2023

Open Access 01-12-2023 | Malnutrition | Case report

Cefcapene pivoxil-induced hypocarnitinemic hypoglycemia in elderly man with subclinical ACTH deficiency: a case report

Authors: Yoshihiro Takahashi, Masanori Murayama, Kaoru Noda, Kengo Yamakawa, Yuya Koide, Rie Yamada, Makoto Hayashi, Keigo Yasuda

Published in: BMC Endocrine Disorders | Issue 1/2023

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Abstract

Background

Drug-induced hypocarnitinemia has been noted as a cause of hypoglycemia in children. However, adult cases are extremely rare and pre-existing conditions (including endocrine disorders and frailty) have been suggested to be involved. Hypoglycemia due to drug-induced hypocarnitinemia is quite rare, and there were few reports of pivoxil-containing cephalosporin (PCC)-induced hypocarnitinemia in adults.

Case presentation

We present a case of an 87-year-old man with malnutrition, and frailty. He developed severe hypoglycemia with unconsciousness after taking cefcapene pivoxil hydrochloride, one of PCC, and hypocarnitinemia was diagnosed. Despite levocarnitine administration, asymptomatic mild hypoglycemia had persisted. Subsequent investigation revealed subclinical ACTH deficiency due to empty sella, which played a key role to maintain mild hypoglycemia as underlying disorder, and PCC-induced hypocarnitinemia triggered severe hypoglycemia. The patient responded to hydrocortisone therapy.

Conclusions

We need to be aware of the facts that PCC can induce severe hypocarnitinemic hypoglycemia in elderly adults associated with frailty, malnutrition, and subclinical ACTH syndrome.
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Metadata
Title
Cefcapene pivoxil-induced hypocarnitinemic hypoglycemia in elderly man with subclinical ACTH deficiency: a case report
Authors
Yoshihiro Takahashi
Masanori Murayama
Kaoru Noda
Kengo Yamakawa
Yuya Koide
Rie Yamada
Makoto Hayashi
Keigo Yasuda
Publication date
01-12-2023
Publisher
BioMed Central
Published in
BMC Endocrine Disorders / Issue 1/2023
Electronic ISSN: 1472-6823
DOI
https://doi.org/10.1186/s12902-023-01314-5

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