Severe hypoglycemia during successful treatment of diffuse hemangiomatosis with propranolol.
A 27-day-old male infant with diffuse hemangiomatosis of the skin and liver was treated with oral propranolol at a dosage of 2 mg/kg per day. Five months later skin and liver hemangiomas regressed almost completely. After 160 days of onset of propranolol, the patient presented with seizures on waking up. Laboratory examinations showed blood glucose of 15 mmol (n.v. 50-110) and increased ketone bodies. Propranolol was recommenced at a lower dosage the day after the crisis and then withdrawn when the baby was aged ten months. Hypoglycemia is the most frequent and insidious side effect of propranolol, mainly occurring in circumstances with diminished oral intake. Although the risk appears small, increased vigilance for hypoglycemia in children on chronic propranolol treatment who have decreased caloric intake for any reason seems prudent.
Pediatric Dermatology Unit, University of Bari, Bari, Italy. ejpd@dermatologiapediatrica.com
Ernesto
E
Bonifazi
Angelo
A
Acquafredda
Antonella
A
Milano
Osvaldo
O
Montagna
Nicola
N
Laforgia
D002149:Energy Intake; D006391:Hemangioma / Q000188:drug therapy*; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced* / Q000175:diagnosis; D007231:Infant, Newborn; D007657:Ketone Bodies / Q000097:blood; D008113:Liver Neoplasms / Q000188:drug therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D011433:Propranolol / Q000009:adverse effects* / Q000627:therapeutic use*; D012878:Skin Neoplasms / Q000188:drug therapy; D016896:Treatment Outcome
D007657:Ketone Bodies; D011433:Propranolol