Oral quinine‐induced hypoglycaemic seizures

A patient with type 1 diabetes mellitus was admitted for investigation of hypoglycaemic seizures. His past medical history included a combined pancreas and kidney transplant, but by the time of admission both organs had failed. As his renal function deteriorated leg cramps were problematic, and so oral quinine had been prescribed. Despite reducing his insulin doses, his glycaemic control became more erratic. His plasma quinine concentration was typical of that expected in high dose intravenous treatment of malaria. On ceasing oral quinine therapy his hypoglycaemic seizures stopped.

This case highlights that in cases of unexplained hypoglycaemic attacks, in patients with some residual endogenous insulin secretion, oral quinine must be excluded as a possible cause. Copyright © 2010 John Wiley & Sons.