A Case Report of Challenging Diagnosis of Persistent Hypoglycemia Secondary to Methadone Dose-Dependence in a Patient With End-Stage Renal Disease (ESRD) and Liver Cirrhosis (LC)

Methadone is a widely used opioid used for the management of chronic pain, treatment for opioid use disorders (heroin addiction), as well as for acute opioid withdrawal syndrome. Even though methadone is considered a safe drug, it is not exempt from unwanted side effects, some of them can be rare and may be overlooked due to patients' comorbidities, delaying proper identification of the actual etiology. This article highlights one of those side effects, hypoglycemia, in a 64-year-old woman with a medical history of end-stage renal disease (ESRD) on hemodialysis, Acquired immune deficiency syndrome, liver cirrhosis, and a history of intravenous (IV) drug abuse disorder on a methadone maintenance program, and the importance of prompt identification and management, such as dose splitting or alternate medication to manage opioid withdrawal. The case underscores the importance of a proper approach and the high clinical suspicion that must be present when multiple variables are in place.