{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T11:40:05Z","timestamp":1781264405358,"version":"3.54.1"},"reference-count":19,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2008,7,4]],"date-time":"2008-07-04T00:00:00Z","timestamp":1215129600000},"content-version":"vor","delay-in-days":3,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabetic Medicine"],"published-print":{"date-parts":[[2008,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p><jats:bold>Background\u2003<\/jats:bold> Central pontine myelinolysis (CPM) usually presents in chronic alcoholics and in patients in whom hyponatraemia has been corrected rapidly. However, CPM may occur in other clinical circumstances, including patients with severe hypoglycaemia. We describe the occurrence of CPM and quadriplegia in a patient who experienced fluoroquinolone\u2010associated severe hypoglycaemia.<\/jats:p><jats:p><jats:bold>Case report\u2003<\/jats:bold> A 63\u2010year\u2010old man with Type\u00a02 diabetes mellitus was admitted to hospital for resection of a large liposarcoma. Renal\u2010dose levofloxacin was utilized as part of an antimicrobial regimen to treat post\u2010operative peritonitis. On days\u00a06\u20138 of levofloxacin therapy, the patient experienced recurrent hypoglycaemia despite total parenteral nutrition, 10% dextrose containing fluids and cessation of insulin therapy 3\u00a0days prior to the first hypoglycaemic episode. Hypoglycaemia resolved within 24\u00a0h of stopping levofloxacin. After a final and severe hypoglycaemic event, the patient developed quadriplegia and tonic left deviation of gaze. Magnetic resonance imaging revealed a high\u2010intensity lesion in the central pons consistent with CPM.<\/jats:p><jats:p><jats:bold>Conclusions\u2003<\/jats:bold> Fluoroquinolones should be considered as a potential cause of hypoglycaemia. Severe hypoglycaemia has the potential to cause white matter lesions in the pons. Putative mechanisms include failure of membrane ion channels, oligodendrocyte apoptosis and oxidative stress of glucose reperfusion. Fluoroquinolone\u2010associated hypoglycaemia and hypoglycaemia\u2010induced quadriplegia are both rare and we believe this is the first case report linking the two events.<\/jats:p>","DOI":"10.1111\/j.1464-5491.2008.02465.x","type":"journal-article","created":{"date-parts":[[2008,7,5]],"date-time":"2008-07-05T17:00:22Z","timestamp":1215277222000},"page":"856-859","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Levofloxacin\u2010associated hypoglycaemia complicated by pontine myelinolysis and quadriplegia"],"prefix":"10.1111","volume":"25","author":[{"given":"S.","family":"Vallurupalli","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Huesmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Gregory","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. G.","family":"Jakoby","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2008,7,4]]},"reference":[{"key":"e_1_2_6_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/archneurpsyc.1959.02340140020004"},{"key":"e_1_2_6_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/0006-8993(93)91564-9"},{"key":"e_1_2_6_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.jnen.0000196131.72302.68"},{"key":"e_1_2_6_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s001340000592"},{"key":"e_1_2_6_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.genhosppsych.2005.03.004"},{"key":"e_1_2_6_7_2","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1096-9136(199803)15:3<259::AID-DIA548>3.0.CO;2-J"},{"key":"e_1_2_6_8_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa055191"},{"key":"e_1_2_6_9_2","doi-asserted-by":"publisher","DOI":"10.1592\/phco.2005.25.10.1296"},{"key":"e_1_2_6_10_2","doi-asserted-by":"publisher","DOI":"10.1592\/phco.2005.25.10.1303"},{"key":"e_1_2_6_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejphar.2004.06.032"},{"key":"e_1_2_6_12_2","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.7.6.613"},{"key":"e_1_2_6_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.23.1.112"},{"key":"e_1_2_6_14_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.24.1.143"},{"key":"e_1_2_6_15_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-5491.2004.01185.x"},{"key":"e_1_2_6_16_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.27.9.1648"},{"key":"e_1_2_6_17_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000155733.65215.c2"},{"key":"e_1_2_6_18_2","doi-asserted-by":"publisher","DOI":"10.1172\/JCI30077"},{"key":"e_1_2_6_19_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.wnr.0000192733.00535.b6"},{"key":"e_1_2_6_20_2","doi-asserted-by":"publisher","DOI":"10.2165\/00002018-199818020-00001"}],"container-title":["Diabetic Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fj.1464-5491.2008.02465.x","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/j.1464-5491.2008.02465.x","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,10]],"date-time":"2023-10-10T10:03:00Z","timestamp":1696932180000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/j.1464-5491.2008.02465.x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2008,7]]},"references-count":19,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2008,7]]}},"alternative-id":["10.1111\/j.1464-5491.2008.02465.x"],"URL":"https:\/\/doi.org\/10.1111\/j.1464-5491.2008.02465.x","archive":["Portico"],"relation":{},"ISSN":["0742-3071","1464-5491"],"issn-type":[{"value":"0742-3071","type":"print"},{"value":"1464-5491","type":"electronic"}],"subject":[],"published":{"date-parts":[[2008,7]]},"assertion":[{"value":"2008-07-04","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}