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Hypoglycaemia: case report A 20-year-old man with insulin-dependent diabetes mellitus developed hypoglycaemia while receiving tramadol/paracetamol [acetaminophen] for a sprain. The man’s diabetes was well controlled with insulin glargine and insulin lispro, with no recent changes in insulin dosages. Following a sprain injury requiring a plaster cast, he received tramadol/paracetamol [Ixprim; dosage not stated] and fondaparinux sodium. As soon as he started treatment, he developed several episodes of hypoglycaemia associated with the ingestion of tramadol/ paracetamol. Initially, he treated the hypoglycaemia with sugar and glucagon; however, he subsequently experienced another hypoglycaemic episode and was admitted to hospital [duration of therapy to reaction onset not clearly stated]. He had a blood glucose level of 0.49 g/L at approximately 3 hours after the last dose of tramadol/ paracetamol. The man received IV glucose and his blood glucose increased to 0.93 g/L. Eleven hours after admission, his blood glucose was 2.56 g/L and insulin therapy was resumed. There were no further episodes of hypoglycaemia over the next 24 hours. He was discharged on insulin therapy and fondaparinux sodium. Tramadol/paracetamol was withdrawn. Author comment: The recurrence of the hypoglycaemic episodes, which coincided with the ingestion of tramadol, highly suggests that this agent played a role. Jonville-Bera A-P, et al. Tramadol-induced hypoglycemia in a diabetic patient. Therapie 65: 499-500, No. 5, Sep-Oct 2010 [French; summarised from a 803054480 translation] - France

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Reactions 21 May 2011 No. 1352