TRIMETHOPRIM SULFAMETHOXAZOLE-INDUCED HYPOGLYCEMIA IN A MALNOURISHED PATIENT WITH SEVERE INFECTION/

Hypoglycemia resulting from the combination of sulfonylurea and sulfon amides is a recognized drug interaction. Hypoglycemia induced by sulfo namides alone may be encountered less frequently. Because of their str uctural similarities to sulfonylureas, sulfonamides are liable to faci litate hypoglycemia by increasing insulin release in susceptible indiv iduals. Sulfonamides can potentiate the hypoglycemic effect of sulfony lurea agents when given in combination. We describe a malnourished pat ient with severe infection who developed hypoglycemia during high-dose trimethoprim/sulfamethoxazole therapy. Elevated C-peptide concentrati ons during the hypoglycemic episode indicate that hypoglycemia resulte d from increased endogenous insulin secretion. As malnourished patient s are prone to hypoglycemia, we suggest that they should be monitored carefully if they are on sulfonamide therapy.