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Sulfonylurea Overdose

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Sulfonylurea Overdose, Sulfonylurea Toxicity, Sulfonylurea Poisoning

  • See Also
  1. Unknown Ingestion
  • Causes
  1. Oral Sulfonylurea antihyperglycemic medications (Chlorpropamide, Glipizide, Glyburide)
  • Findings
  • Signs and Symptoms
  1. Confusion
  2. Coma
  3. Decreased Appetite
  4. Dizziness
  5. Hypoglycemia
  6. Lethargy
  7. Seizures
  8. Weakness (Hemiparesis may occur)
  • 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
  • Evaluation
  1. See Unknown Ingestion
  • 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)
  • 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)
  • 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
  • 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]
  4. Vega (2024) Am Fam Physician 109(2): 143-53 [PubMed]