Mercaptopurine
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Ketotic hypoglycaemia in a child: case report A 5-year-old boy with acute lymphoblastic leukaemia (ALL) developed ketotic hypoglycaemia while receiving treatment with mercaptopurine. The boy was receiving mercaptopurine daily 75 mg/m2 per dose per day, as maintenance therapy [route not stated]. Two months after he began his first maintenance phase (day 62) he was found unresponsive. His glucose level was 22 mg/dL. He experienced nausea, diaphoresis, and vomiting at a frequency of > 20 episodes/month. He had repeated episodes of hypoglycaemia which were detected by home glucose monitoring. They usually occurred 9–13h after an overnight fast. He was admitted to an ICU during his second maintenance phase for a formal overnight fasting protocol. His glucose level decreased to 49 mg/dL after 12h. He received glucagon and the increase in his glucose level was < 5 mg/dL. Urine organic acid testing revealed an elevated 3-hydroxybutyric acid level, which indicated ketosis. The timing of mercaptopurine dosing was changed to the morning instead of the evening. The boy received cornstarch 5 hours before each dose of mercaptopurine 1 week after the fasting study had been conducted. His symptomatic hypoglycaemic events reduced to less than two episodes per month. Three months after chemotherapy cessation, he underwent a 15h fasting study. His glucose level was normal. Author comment: "Our patient had symptomatic hypoglycemia associated with [mercaptopurine] maintenance therapy for ALL". Visavachaipan N, et al. Continuous glucose monitoring: A valuable monitoring tool for management of hypoglycemia during chemotherapy for acute lymphoblastic leukemia. Diabetes Technology and Therapeutics 15: 97-100, No. 1, Jan 2013. Available from: URL: http://dx.doi.org/10.1089/dia.2012.0181 803085695 USA
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Editorial comment: This case report was previously summarised from an abstract [see Reactions 1359 p25-26; 803056745].
0114-9954/10/1447-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 13 Apr 2013 No. 1447
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