Refractory hypoglycemia secondary to topical salicylate intoxication
R. Raschke, P. A. Arnold-Capell, R. Richeson and S. C. Curry
Department of Internal Medicine, Good Samaritan Regional Medical Center, Phoenix, Ariz. 85006.
We describe a case of severe refractory hypoglycemia secondary to topical
salicylate intoxication. A 72-year-old man with psoriasis and end-stage
renal disease was treated with a topical cream containing 10% salicylic
acid. The patient presented with encephalopathy and subsequently developed
hypoglycemia refractory to infusions of large amounts of glucose. A serum
salicylate concentration was elevated at 3.2 mmol/L. Emergent hemodialysis
was accompanied by rapid lowering of serum salicylate concentration and
resolution of refractory hypoglycemia. Salicylate is well absorbed across
normal and diseased skin. Salicylate markedly impairs gluconeogenesis and
increases glucose utilization, resulting in hypoglycemia. To our knowledge,
this is the first article on hypoglycemia due to the application of topical
salicylate.
