SEVERE HYPERGLYCEMIA DURING GATIFLOXACIN THERAPY IN PATIENTS WITHOUT DIABETES

Objective: To present two cases of severe hyperglycemia in patients without diabetes who received gati-floxacin therapy. Methods: We describe the histories, clinical findings, and hospital courses of two women in whom severe hyperglycemia developed after gatifloxacin therapy was initiated. Interacting factors that may result in severe hyperglycemia in patients without diabetes and the literature explaining the mechanism by which gatifloxacin can alter glucose metabolism are reviewed. Results: Our first patient, a 46-year-old woman with end-stage renal disease, presented with a 3-day history of fever, abdominal pain, and hypotension. Admission laboratory data included a fasting plasma glucose level of 72 mg/dL and a glycosylated hemoglobin of 5.3%. She was treated with gatifloxacin for an infected ovarian cyst found on laparotomy. Her subsequent glucose values ranged from 400 to 500 mg/dL and remained high during gati-floxacin therapy. Antibiotic treatment was changed to ciprofloxacin. On outpatient follow-up, the patient's fasting plasma glucose levels had decreased to a range of 87 to 108 mg/dL. Our second patient, a 77-year-old woman with a history of chronic renal failure and congestive heart failure, was hospitalized because of dyspnea and hypotension. She was given gatifloxacin for a urinary tract infection. Her daily fasting plasma glucose value gradually increased from 100 mg/dL on admission to 694 mg/dL on the 6th hospital day. The patient required insulin therapy throughout her hospitalization, and she died on the 12th hospital day. Conclusion: Gatifloxacin therapy may precipitate severe hyperglycemia in patients without diabetes, especially in the elderly population, those with renal insufficiency, and those receiving multiple drugs known to alter glucose metabolism. Discontinuation of gatifloxacin treatment may result in improved glucose homeostasis. (Endocr Pract. 2004;10:40-44)