Citation

Tang Z, Fan X, Feng Z, Han B, Guo N. Front. Pharmacol. 2022; 13.

Copyright

(Copyright © 2022, Frontiers Media)

DOI

10.3389/fphar.2022.955162

PMID

unavailable

Abstract

Rhabdomyolysis is a life-threatening syndrome associated with direct or indirect muscle damage that is rarely reported with dipeptidyl peptidase (DPP)-4 inhibitors. Here we presented a case in which a 58-year-old female suffered from severe swelling and pain in bilateral lower limbs and oliguria after a suicidal vildagliptin overdose. Drug-induced rhabdomyolysis and drug-induced liver injury were diagnosed based on laboratory and radiological findings. The patient was treated with fluid resuscitation, insulin, electrolyte replacement, diuretics, urine alkalizing agents, anticoagulants, antioxidants, and 24-h bedside ECG monitoring and suicide prevention. After 20 days of hospitalization and close monitoring, the patient was discharged without sequelae. Risk factors, diagnostic criteria, disease mechanisms, and outcomes were also discussed. This case illustrated that overdose of oral anti-diabetic medications may result in clinically significant adverse events, such as rhabdomyolysis in this case with a DPP-4 inhibitor. Although the incidence is low, special attention should be paid to intentional or accidental exposure to anti-diabetic medications during suicide attempts, especially in depressed patients with diabetes. Copyright © 2022 Tang, Fan, Feng, Han and Guo.

Language: en

Keywords

adult; human; female; case report; depression; suicide attempt; disease severity; overdose; rhabdomyolysis; clinical article; middle aged; nuclear magnetic resonance imaging; Streptococcus infection; patient compliance; hypertension; glucose blood level; alanine aminotransferase; aspartate aminotransferase; creatine kinase; glucose; bicarbonate; protein blood level; urea; non insulin dependent diabetes mellitus; electrocardiography monitoring; nitrogen; lactate dehydrogenase; lactic acidosis; oliguria; diabetic ketoacidosis; lactate blood level; urea nitrogen blood level; Article; leg edema; medical history; alanine aminotransferase blood level; aspartate aminotransferase blood level; fluid resuscitation; urine volume; nifedipine; liver function test; myoglobin; lactic acid; D dimer; vildagliptin; ketone; insulin aspart; dalteparin; thioctic acid; DPP-4 inhibitor; pig insulin; procalcitonin; cefminox; dorsalis pedis artery; Escherichia coli infection; Neisseriaceae infection