Pharm
Sulfonylurea Overdose
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Sulfonylurea Overdose
, Sulfonylurea Toxicity
Causes
Oral
Sulfonylurea
antihyperglycemic medications (
Chlorpropamide
,
Glipizide
,
Glyburide
)
Findings
Signs and Symptoms
Confusion
Coma
Decreased Appetite
Dizziness
Hypoglycemia
Lethargy
Seizure
s
Weakness (
Hemiparesis
may occur)
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
Sulfonylurea
s
Evaluation
See
Unknown Ingestion
Management
Adults
Dextrose 50%
IV bolus 1-2 ml/kg
Followed by continuous infusion (dose based on degree of
Hypoglycemia
)
Octreotide
(
Sandostatin
) 50-150 mcg/dose SQ twice to three times daily
Blocks pancreatic beta-islet cell
Insulin
release
Glucagon
1 mg per dose and may repeat every 20 minutes
Only transient elevation in
Glucose
to temporize until definitive other management
Management
Children
Dextrose bolus followed by continuous infusion
See
Dextrose Rule of 50
Age 1 to 24 months:
Dextrose 25%
IV 2-4 ml/kg
Age >24 months:
Dextrose 50%
IV 1-2 ml/kg
Octreotide
(
Sandostatin
) 1 to 1.5 mcg/kg (up to 50 mcg) SQ every 6 hours
Blocks pancreatic beta-islet cell
Insulin
release
Glucagon
Infants: 0.025 mg/kg/dose every 20 minutes
Children: 0.5 mg/dose every 20 minutes
Only transient elevation in
Glucose
to temporize until definitive other management
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
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]
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