II. Causes
- Oral Sulfonylurea antihyperglycemic medications (Chlorpropamide, Glipizide, Glyburide)
III. Findings: Signs and Symptoms
- Confusion
- Coma
- Decreased Appetite
- Dizziness
- Hypoglycemia
- Lethargy
- Seizures
- Weakness (Hemiparesis may occur)
IV. Precautions
-
One Pill Can Kill
- Even a single tablet can cause symptomatic Hypoglycemia in children
- Risk of delayed or prolonged Hypoglycemia
- Agent half-lives vary, but range from 2-36 hours (in Overdose, may last >24 hours)
- Hepatic excretion is typical for Sulfonylureas
V. Evaluation
VI. Management: Adults
-
Dextrose 50% (0.5 g/ml, or 25 g per 50 ml vial)
- Administer 25 gram ampule (up to 1-2 ml/kg or 1 g/kg) IV bolus
- Followed by continuous infusion (dose based on degree of Hypoglycemia)
- Avoid dextrose monotherapy (triggers Insulin release, and prolonged Hypoglycemia)
-
Octreotide (Sandostatin)
- Dose: 50-150 mcg/dose SQ twice to three times daily (or 50 mcg every 6 hours)
- Blocks pancreatic beta-islet cell Insulin release
- Glucagon
VII. Management: Children
- Dextrose bolus followed by continuous infusion
- See Dextrose Rule of 50
- Age 1 to 24 months: Dextrose 25% (0.25 g/ml) IV 2-4 ml/kg
- Age >24 months: Dextrose 50% (0.5 g/ml) IV 1-2 ml/kg
- Avoid dextrose monotherapy (triggers Insulin release, and prolonged Hypoglycemia)
-
Octreotide (Sandostatin)
- Dose: 1 to 1.5 mcg/kg (up to 50 mcg) SQ every 6 hours
- Blocks pancreatic beta-islet cell Insulin release
- Glucagon
VIII. Management: Disposition
- Adults - Asymptomatic
- Observe for 8-12 hours for delayed Hypoglycemia
- Adults - Hypoglycemia
- See Hypoglycemia Management
- Observe for 24 hours
- Children
- Observe for 24 hours
IX. References
- Riddle and Tomaszewski (2018) Crit Dec Emerg Med 32(2): 32
- Harrigan (2001) Ann Emerg Med 38(1): 68-78 [PubMed]
- Rath (2008) J Paeditr Child Health 44(6): 383-4 [PubMed]
- Vega (2024) Am Fam Physician 109(2): 143-53 [PubMed]