title: Fatal hypoglycemia with levofloxacin use in an elderly patient in the post-operative period.
abstract: OBJECTIVE
  Fluoroquinolones are antimicrobial agents with a broad spectrum of activity against gram-positive, gram-negative, and anaerobic organisms. They are widely used in surgical practice and are generally considered safe. Hypoglycemia because of use of levofloxacin is a rarely reported complication. This report of a case of a surgical patient highlights this potentially fatal complication.
  
  
  METHODS
  An elderly, non-diabetic patient with renal impairment presented with a possible duodenal perforation. After successful surgery, the patient developed recurrent hypoglycemic episodes in the post-operative period after use of levofloxacin. Delay in recognition of the cause of hypoglycemia led to irreversible brain damage and death.
  
  
  RESULTS
  The calculated Naranjo adverse drug reaction probability scale criteria suggest the possibility that these episodes were related to levofloxacin. The mechanism of hypoglycemia with levofloxacin relates to the potential inhibition of the K(ATP) channel on the pancreatic beta cell by the drug.
  
  
  CONCLUSIONS
  The case report highlights the need to be aware of this potentially fatal complication of a drug commonly used in surgical practice.
authors.affiliation: Department of Anesthesia and Critical Care, Christian Medical College and Hospital, Ludhiana, Punjab, 632004, India.
authors.forename: Madhurita
authors.initials: M
authors.lastname: Singh
authors.forename: Jubbin Jagan
authors.initials: JJ
authors.lastname: Jacob
authors.forename: Rajeev
authors.initials: R
authors.lastname: Kapoor
authors.forename: John
authors.initials: J
authors.lastname: Abraham
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use / Q000633:toxicity*; D004359:Drug Therapy, Combination; D004381:Duodenal Ulcer / Q000601:surgery*; D017809:Fatal Outcome; D006801:Humans; D006946:Hyperinsulinism / Q000139:chemically induced; D007003:Hypoglycemia / Q000139:chemically induced*; D007262:Infusions, Intravenous; D064704:Levofloxacin; D008297:Male; D015242:Ofloxacin / Q000627:therapeutic use / Q000633:toxicity*; D010439:Peptic Ulcer Perforation / Q000601:surgery*; D010538:Peritonitis / Q000601:surgery; D011182:Postoperative Care; D011183:Postoperative Complications / Q000139:chemically induced*; D012008:Recurrence
chemical_list: D000900:Anti-Bacterial Agents; D064704:Levofloxacin; D015242:Ofloxacin