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.
METHODS: 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.
METHODS: 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.
摘要：
背景：药物诱导的低肉碱血症已被认为是儿童低血糖的一个原因。然而,成人病例极为罕见,已有的疾病(包括内分泌失调和虚弱)被认为与之相关.由药物引起的低肉碱血症引起的低血糖非常罕见，在成人中含头孢菌素酯（PCC）引起的低肉碱血症的报道很少。
方法：我们介绍一个87岁的营养不良患者，和脆弱。服用盐酸头孢昔酯后出现严重低血糖，意识不清，PCC之一，诊断为低肉碱血症。尽管服用了左卡尼汀,无症状的轻度低血糖持续存在.随后的调查显示亚临床ACTH缺乏由于空蝶鞍，在维持轻度低血糖作为潜在疾病方面发挥了关键作用，PCC诱导的低肉碱血症引发了严重的低血糖。患者对氢化可的松治疗有反应。
结论：我们需要注意的事实是，PCC可以在与虚弱相关的老年人中引起严重的低肉碱血症性低血糖，营养不良,亚临床ACTH综合征。
方法：我们介绍一个87岁的营养不良患者，和脆弱。服用盐酸头孢昔酯后出现严重低血糖，意识不清，PCC之一，诊断为低肉碱血症。尽管服用了左卡尼汀,无症状的轻度低血糖持续存在.随后的调查显示亚临床ACTH缺乏由于空蝶鞍，在维持轻度低血糖作为潜在疾病方面发挥了关键作用，PCC诱导的低肉碱血症引发了严重的低血糖。患者对氢化可的松治疗有反应。
结论：我们需要注意的事实是，PCC可以在与虚弱相关的老年人中引起严重的低肉碱血症性低血糖，营养不良,亚临床ACTH综合征。
