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[Overdosage of glibenclamide presenting with lethargy and seizures in a child]
Insights
Accidental glibenclamide overdose in toddlers can cause severe hypoglycemia. Delayed diagnosis is common when ingestion history is initially withheld, highlighting the need for vigilance in pediatric emergency care.
Area of Science:
- Pediatrics
- Toxicology
- Emergency Medicine
Background:
- Accidental ingestion of oral hypoglycemic agents in children presents diagnostic challenges.
- Delayed presentation of symptoms can obscure the history of overdose.
Observation:
- A 21-month-old girl experienced lethargy and seizures 12 hours post-ingestion of glibenclamide.
- Initial blood glucose was critically low at 0.5 mM/l.
- Symptoms resolved rapidly with intravenous glucose administration.
Findings:
- Metabolic and infectious causes of hypoglycemia were excluded.
- The child had ingested her father's glibenclamide pills.
- Initial denial of ingestion by parents complicated the diagnostic process.
Implications:
- This case underscores the importance of thorough history-taking in pediatric overdose cases.
- Early recognition and management of glibenclamide-induced hypoglycemia are crucial.
- Pediatric healthcare providers must consider drug ingestion even when initially denied.
Abstract:
Management of accidental overdosage with oral hypoglycemic agents in toddlers may be difficult when the history of ingestion is overlooked. We report a 21-month-old girl who presented with lethargy and generalized seizures 12 hours after ingestion of an unknown number of glibenclamide pills. The blood glucose on admission was 0.5 mM/l. Symptoms resolved promptly after an intravenous bolus of glucose. Metabolic and infectious causes of hypoglycemia were ruled out. The parents denied drug ingestion initially, but further investigation revealed that she had ingested several glibenclamide pills used by her diabetic father 12 hours prior to admission. This case illustrates the problem involved in diagnosis and management of accidental drug overdosage in children when no such history is elicited and symptoms are delayed.