II. Causes

  1. Oral Sulfonylurea antihyperglycemic medications (Chlorpropamide, Glipizide, Glyburide)

III. Findings:Signs and Symptoms

  1. Confusion
  2. Coma
  3. Decreased Appetite
  4. Dizziness
  5. Hypoglycemia
  6. Lethargy
  7. Seizures
  8. Weakness (Hemiparesis may occur)

IV. Precautions

  1. One Pill Can Kill
    1. Even a single tablet can cause symptomatic Hypoglycemia in children
  2. Risk of delayed or prolonged Hypoglycemia
    1. Agent half-lives vary, but range from 2-36 hours (in Overdose, may last >24 hours)
    2. Hepatic excretion is typical for Sulfonylureas

V. Evaluation

VI. Management: Adults

  1. Dextrose 50% IV bolus 1-2 ml/kg
    1. Followed by continuous infusion (dose based on degree of Hypoglycemia)
  2. Octreotide (Sandostatin) 50-150 mcg/dose SQ twice to three times daily
    1. Blocks pancreatic beta-islet cell Insulin release
  3. Glucagon 1 mg per dose and may repeat every 20 minutes
    1. Only transient elevation in Glucose to temporize until definitive other management

VII. Management: Children

  1. Dextrose bolus followed by continuous infusion
    1. Age 1 to 24 months: Dextrose 25% IV 2-4 ml/kg
    2. Age >24 months: Dextrose 50% IV 1-2 ml/kg
  2. Octreotide (Sandostatin) 1 to 1.5 mcg/kg (up to 50 mcg) SQ every 6 hours
    1. Blocks pancreatic beta-islet cell Insulin release
  3. Glucagon
    1. Infants: 0.025 mg/kg/dose every 20 minutes
    2. Children: 0.5 mg/dose every 20 minutes
    3. Only transient elevation in Glucose to temporize until definitive other management

VIII. Management: Disposition

  1. Adults - Asymptomatic
    1. Observe for 8-12 hours for delayed Hypoglycemia
  2. Adults - Hypoglycemia
    1. See Hypoglycemia Management
    2. Observe for 24 hours
  3. Children
    1. Observe for 24 hours

IX. References

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