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% (0.5 g/ml, or 25 g per 50 ml vial)
    1. Administer 25 gram ampule (up to 1-2 ml/kg or 1 g/kg) IV bolus
    2. Followed by continuous infusion (dose based on degree of Hypoglycemia)
    3. Avoid dextrose monotherapy (triggers Insulin release, and prolonged Hypoglycemia)
  2. Octreotide (Sandostatin)
    1. Dose: 50-150 mcg/dose SQ twice to three times daily (or 50 mcg every 6 hours)
    2. Blocks pancreatic beta-islet cell Insulin release
  3. Glucagon
    1. Dose: 1 mg IM/SQ per dose and may repeat every 20 minutes
    2. Only transient elevation in Glucose to temporize until definitive other management (esp. IV Access)

VII. Management: Children

  1. Dextrose bolus followed by continuous infusion
    1. See Dextrose Rule of 50
    2. Age 1 to 24 months: Dextrose 25% (0.25 g/ml) IV 2-4 ml/kg
    3. Age >24 months: Dextrose 50% (0.5 g/ml) IV 1-2 ml/kg
    4. Avoid dextrose monotherapy (triggers Insulin release, and prolonged Hypoglycemia)
  2. Octreotide (Sandostatin)
    1. Dose: 1 to 1.5 mcg/kg (up to 50 mcg) SQ every 6 hours
    2. 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 (esp. IV Access)

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

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