Endocrinology Book

//fpnotebook.com/

Sulfonylurea Overdose

Aka: Sulfonylurea Overdose, Sulfonylurea Toxicity
  1. Causes
    1. Oral Sulfonylurea antihyperglycemic medications (Chlorpropamide, Glipizide, Glyburide)
  2. Findings:Signs and Symptoms
    1. Confusion
    2. Coma
    3. Decreased Appetite
    4. Dizziness
    5. Hypoglycemia
    6. Lethargy
    7. Seizures
    8. Weakness (Hemiparesis may occur)
  3. 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
  4. Evaluation
    1. See Unknown Ingestion
  5. 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
  6. 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
  7. 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
  8. References
    1. Riddle and Tomaszewski (2018) Crit Dec Emerg Med 32(2): 32
    2. Harrigan (2001) Ann Emerg Med 38(1): 68-78 [PubMed]
    3. Rath (2008) J Paeditr Child Health 44(6): 383-4 [PubMed]

You are currently viewing the original 'fpnotebook.com\legacy' version of this website. Internet Explorer 8.0 and older will automatically be redirected to this legacy version.

If you are using a modern web browser, you may instead navigate to the newer desktop version of fpnotebook. Another, mobile version is also available which should function on both newer and older web browsers.

Please Contact Me as you run across problems with any of these versions on the website.

Navigation Tree