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Continuous octreotide infusion for sulfonylurea-induced hypoglycemia in a toddler

Rebecca Llamado1, Angela Czaja, Nicholas Stence

  • 1Department of Pediatrics.

The Journal of Emergency Medicine
|July 6, 2013
PubMed

Insights

Continuous octreotide infusion effectively managed severe sulfonylurea-induced hypoglycemia and neurologic dysfunction in a toddler. This method achieved tight glucose control and fluid management, leading to near-complete neurologic recovery.

Area of Science:

  • Pediatric Emergency Medicine
  • Clinical Pharmacology
  • Toxicology

Background:

  • Sulfonylurea ingestion in toddlers can lead to severe hypoglycemia and neurological complications.
  • Current management for mild cases involves dextrose and octreotide boluses.
  • Optimal treatment for severe hypoglycemia with cerebral injury remains unclear.

Purpose of the Study:

  • To report the successful use of continuous octreotide infusion for glucose control in a toddler with sulfonylurea ingestion and severe neurologic dysfunction.
  • To highlight a novel approach for managing complex cases of accidental sulfonylurea poisoning.

Main Methods:

  • A 17-month-old child ingested glipizide, presenting with severe hypoglycemia, cerebral edema, and seizures.
  • Intravenous dextrose and subcutaneous octreotide were ineffective.
  • Continuous intravenous octreotide infusion was initiated with high-concentration dextrose for precise glucose and fluid management.

Main Results:

  • Continuous octreotide infusion rapidly stabilized blood glucose levels.
  • Fluid restriction goals were successfully maintained.
  • Diffuse cerebral edema showed reversibility, with near-complete neurologic function recovery.

Conclusions:

  • Continuous octreotide infusion offers an effective alternative to bolus administration for severe sulfonylurea-induced hypoglycemia.
  • This approach facilitates tight glucose and fluid control, crucial in managing associated cerebral edema and neurologic injury.
  • The case suggests continuous octreotide infusion may be preferable for pediatric sulfonylurea poisoning with neurological sequelae.
Abstract

Keywords:
cerebral edemaglipizidehypoglycemiamagnetic resonance imagingpediatrics

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