Another dangerous combination for hypoglycemic coma: concurrent use of sibutramine and lorazepam.

Another dangerous combination for hypoglycemic coma: concurrent use of sibutramine and lorazepam Sir, With increasing demands to treat obesity in both medical and psychological aspects, many drugs are developed to lower human body weight. Those widely used anti-obesity drugs, such as olistat and sibutramine, are generally safe. But serious adverse effects could be developed when it is concurrently used with other medications. We report a patient who developed hypoglycemic coma due to concurrent use of sibutramine and lorazepam. A 32-year-old woman presented to the emergency department because of disturbed consciousness and an episode of generalized seizure attack. On arrival, she was comatose with a blood pressure 108/ 58 mmHg, pulse rate 96 beat/min, respiration rate 20 breath/min and body temperature 35.6 C. The result of a focused neurologic examination was normal. A capillary blood glucose measurement was 27 mg/dl. She regained consciousness promptly after treated with bolus of 50% dextrose and continuous infusion of 10% dextrose. She had no history of systemic illness. She was treated with sibutramine 10 mg per day by another hospital due to overweight. She developed insomnia, for which she used lorazepam 2 mg on as needed basis. Her families stated that she complied poorly with follow-up program and had no food intake for less than 12 h prior to admission. Her BMI was 22 at this presentation. The laboratory data including complete blood count, liver function tests and serum creatinine were normal. The serum ethanol level was zero, but she had a positive urinary test for benzodiazepine. An endocrinologist was consulted and she was admitted. At the ward, her serum glucose levels were checked every hour and no further hypogly-cemic episode was noted. Her albumin and total protein were 3.8 and 6.5 g/dl, respectively. She had a insulin level of 5.2 mU/ml (normal range, 5–25 mU/ ml), a negative urinary sulfonylurea screening test and a suppressible C-peptide suppression test. She had a normal serum cortisol level of 21.66 mg/dl at 8:00 a.m. and a normal human growth hormone of 0.1 ng/ml. Her thyroid function panel was also normal (triiodothyronine 89.26 ng/dl; thyroid-stimulating hormone 1.62 mU/ml; and free thyroxine 1.61 ng/dl). The magnetic resonance imaging of the abdomen showed no pancreatic mass. She was discharged on the 5th hospital day. On follow-up at clinic for 6 months, she no longer had hypoglyce-mic episode. This young woman who used sibutramine and lorazepam concurrently developed hypoglycemic coma after …