Archives of Disease in Childhood, Vol 64, 1496-1500, Copyright © 1989 by Archives of Disease in Childhood.
Complications of diazoxide treatment in persistent neonatal hyperinsulinism
YK Abu-Osba, KB Manasra and PM Mathew
Neonatology/Perinatology Section, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Seven infants with persistent neonatal hyperinsulinism were treated in
Dhahran Health Centre from 1983 to 1986. The insulin:glucose ratio (serum
insulin concentration pmol/l) divided by the blood glucose concentration
(mmol/l) ranged from 12 to 636, mean (SD) 177 (201). To control
hypoglycaemia, diazoxide (12-24 mg/kg/day) was given in a continuous
intravenous glucose infusion (12-22 mg/kg/min) on 11 separate occasions,
four infants twice each and three infants once each. An increase of more
than one standard deviation in the heart and respiratory rates, together
with other symptoms of heart failure, was considered to be evidence of
diazoxide toxicity. Cardiorespiratory failure (toxicity) occurred on eight
of the 11 occasions (73%) in seven infants. The average daily fluid intake,
weight change, respiratory rate and heart rate before treatment were
similar whether or not the infant developed toxicity. A diazoxide toxicity
index was obtained by multiplying the dose of diazoxide by the
insulin:glucose ratio to relate the diazoxide dose to the severity of the
disease. In all instances when the toxicity index was more than 1533 (mean
(SD) 3732 (2741) cardiac toxicity developed. In contrast, infants with a
toxicity index of less than 675 (mean (SD) 364 (270), had no symptoms of
toxicity. Symptoms were significantly related to the severity of the
disease and the diazoxide dose. It is possible to use the toxicity index to
predict the risk of toxicity and to calculate a safe dose of diazoxide in
infants with persistent neonatal hyperinsulinism.
