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Published on: June 11, 2012
Sulfonylurea intoxication at a tertiary care paediatric hospital
Miguel Glatstein1, Facundo Garcia-Bournissen, Dennis Scolnik
1Division of Pediatric Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Canada.
Insights
Sulfonylurea drug ingestion can cause severe hypoglycemia in children. Octreotide (a glucose-lowering drug) effectively treated two young children with glyburide-induced hypoglycemia, suggesting it as a preferred treatment.
Area of Science:
- Pediatric Toxicology
- Endocrinology
Background:
- Sulfonylurea drugs, used to lower blood sugar, pose a significant poisoning risk to children.
- Accidental ingestion of even small amounts can be life-threatening.
- Experience with octreotide, a potential treatment for persistent hypoglycemia, is limited in pediatric cases.
Purpose of the Study:
- To review clinical features and outcomes of sulfonylurea ingestion in children.
- To evaluate the effectiveness of octreotide in managing severe hypoglycemia in pediatric patients.
Main Methods:
- Retrospective chart review of pediatric patients with sulfonylurea exposure.
- Data collected from April 2001 to November 2008 at the Hospital for Sick Children, Toronto.
Main Results:
- Ten children with sulfonylurea exposure were identified; four had confirmed overdoses (mean age 8.2 years).
- All four confirmed cases involved glyburide and resulted in severe hypoglycemia.
- Two toddlers treated with octreotide and glucose infusions showed favorable responses without rebound hypoglycemia, unlike two teenagers treated with glucose alone.
Conclusions:
- Glyburide-induced hypoglycemia is severe in pediatric cases.
- Octreotide demonstrated effectiveness in treating hypoglycemia in young children, supporting its consideration as a primary treatment option.
Background:
Unintentional poisoning with sulfonylurea hypoglycaemic drugs is a serious danger to infants and children, as the ingestion of relatively small amounts can be fatal. Although the administration of octreotide is considered effective in patients that remain hypoglycaemic despite glucose administration, experience in children is limited.
Methods:
A retrospective chart review of the clinical features of all children following sulfonylurea ingestion presenting between April 2001 and November 2008 at the Hospital for Sick Children in Toronto.
Results:
Ten children were identified with sulfonylurea exposure; six were classified as suspected ingestion and four had confirmed signs of sulfonylurea overdoses (mean age: 8.2 years; range 1.5 - 15). All four patients with confirmed ingestion were exposed to glyburide and developed severe hypoglycaemia; two were toddlers and two teenagers. Ingestion was accidental in the case of the toddlers, and suicidal attempts in the case of the adolescents. All patients were initially treated with glucose infusions. Both toddlers also received octreotide with favourable response and no rebound hypoglyacemia. The two teenagers were treated only with prolonged glucose infusions; in both cases rebound hypoglycaemia and increased glucose requirements were observed.
Discussion:
Glyburide-induced hypoglycaemia was pronounced in all patients identified. Treatment with octreotide proved effective in the 2 infants treated, agreeing with the limited experience reported to date in the literature, and suggesting that octreotide should be considered the treatment of choice in children.
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