title: Carnitine-related hypoglycemia caused by 3 days of pivalate antibiotic therapy in a patient with severe muscular dystrophy: a case report.
abstract: Long-term treatment with antibiotics containing pivalic acid may decrease serum carnitine concentration and can sometimes be associated with severe hypoglycemia and encephalopathy in infants. Little has been reported, however, on severe hypocarnitinemia induced by acute administration in older children.
  
  
  
  We describe a 6-year-old Japanese girl with Fukuyama-type congenital muscular dystrophy who lost consciousness after 3 days of treatment with an antibiotic containing pivalic acid (cefditoren pivoxil). Investigations at the onset of unconsciousness revealed hypoglycemia (free plasma glucose concentration: 31 mg/dL) and hypocarnitinemia (serum free carnitine concentration: 6.2 μmol/L). Intravenous administration of glucose rapidly improved her symptoms without any complications. Serum free carnitine concentration was 29.0 μmol/L immediately prior to the initiation of cefditoren pivoxil. Computed tomography scanning showed severe peripheral skeletal muscle atrophy, indicating the likelihood of decreased carnitine stores in skeletal muscle.
  
  
  
  Although serum carnitine concentration can appear deceptively normal, skeletal muscle carnitine stores can be reduced in patients with severe muscular atrophy. Even a short course of a pivalate-containing antibiotic can lead to life-threatening hypocarnitinemia in older children with severe muscular dystrophy.
authors.affiliation: Department of Pediatrics Ehime University Graduate School of Medicine, 454 Shitsukawa, Toon, Ehime, 790-0295, Japan. multiple.pd@gmail.com.
authors.forename: Masanori
authors.initials: M
authors.lastname: Ito
authors.affiliation: Department of Pediatrics Ehime University Graduate School of Medicine, 454 Shitsukawa, Toon, Ehime, 790-0295, Japan.
authors.forename: Mitsumasa
authors.initials: M
authors.lastname: Fukuda
authors.affiliation: Ehime Rehabilitation Center for Children, Toon, Ehime, Japan.
authors.forename: Yuka
authors.initials: Y
authors.lastname: Suzuki
authors.affiliation: Ehime Rehabilitation Center for Children, Toon, Ehime, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Wakamoto
authors.affiliation: Department of Pediatrics Ehime University Graduate School of Medicine, 454 Shitsukawa, Toon, Ehime, 790-0295, Japan.
authors.forename: Eiichi
authors.initials: E
authors.lastname: Ishii
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D002331:Carnitine / Q000097:blood / Q000172:deficiency*; D002511:Cephalosporins / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000175:diagnosis / Q000209:etiology*; D010612:Pharyngitis / Q000150:complications / Q000188:drug therapy*; D058494:Walker-Warburg Syndrome / Q000097:blood / Q000150:complications*
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers; D002511:Cephalosporins; C057710:cefditoren pivoxil; D002331:Carnitine
keywords: Antibiotics; Carnitine; Fukuyama-type congenital muscular dystrophy; Hypoglycemia; Pivalic acid