Clinical spectrum of sulfonylurea overdose and experience with diazoxide therapy

We retrospectively reviewed our 10-year experience with the management of sulfonylurea overdose. There were 40 overdoses in 37 patients aged 1 to 78 years, with two deaths and one patient being left in a chronic vegetative state. Blood sugar levels ranged from normal to severe recalcitrant hypoglycemia. Maximal duration of recurrent hypoglycemia was 82 hours. In 21 of 31 patients with hypoglycemia, response to hypertonic glucose therapy was poor, resulting in recurrent hypoglycemia. Six of these patients were treated with intravenous diazoxide and had prompt correction. Overdose of sulfonylurea drugs may produce severe, protracted hypoglycemia poorly responsive to hypertonic glucose therapy. Treatment with diazoxide is rational and effective and may be lifesaving.