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Hypoglycemia in a healthy toddler

Miguel Glatstein1, Facundo Garcia-Bournissen, Dennis Scolnik

  • 1Division of Pediatric Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario, Canada.

Therapeutic Drug Monitoring
|January 15, 2009
PubMed

Insights

Sulfonylurea ingestion is a serious threat to toddlers, causing prolonged hypoglycemia. This case highlights Munchausen-by-proxy syndrome as a cause of non-accidental sulfonylurea poisoning in a child.

Area of Science:

  • Pediatric Toxicology
  • Endocrinology
  • Child Abuse and Neglect

Background:

  • Sulfonylureas are potent oral hypoglycemic agents used in type 2 diabetes.
  • Accidental or intentional ingestion in toddlers can lead to severe, prolonged hypoglycemia.
  • The

Observation:

  • An 18-month-old girl presented with altered mental status and severe hypoglycemia requiring intensive glucose management.
  • Family history of type 2 diabetes led to testing for sulfonylureas.
  • Serum analysis confirmed sulfonylurea presence, indicating intentional ingestion.

Findings:

  • The child's hypoglycemia was attributed to non-accidental sulfonylurea ingestion.
  • Investigation revealed the mother's Munchausen-by-proxy syndrome as the cause.
  • Over 20% of reported sulfonylurea poisonings involve abuse or homicide attempts.

Implications:

  • Clinicians should consider sulfonylurea intoxication in unexplained pediatric hypoglycemia.
  • Suspected child abuse or neglect requires careful evaluation in such cases.
  • Management involves glucose infusion, avoiding boluses to prevent rebound hyperinsulinism.

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