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Five year retrospective evaluation of sulfonylurea ingestion in children
D A Quadrani1, H A Spiller, P Widder
1Western New York Regional Poison Control Center, Children's Hospital of Buffalo 14222, USA.
Insights
Accidental ingestion of oral hypoglycemic medications by children can lead to significant hypoglycemia. Even a single tablet of certain sulfonylureas can cause dangerously low blood glucose, requiring 24-hour medical observation.
Area of Science:
- Pediatric Toxicology
- Endocrinology
Background:
- Oral hypoglycemic agents are common for Type II diabetes.
- Accidental pediatric ingestions of these medications are a concern.
- Limited pediatric data exists on poison control center experiences.
Purpose of the Study:
- To assess the toxicity of oral sulfonylurea ingestion in children.
- To evaluate the effectiveness of treatments for these ingestions.
Main Methods:
- Retrospective review of oral sulfonylurea ingestions reported to a regional poison control center (1987-1991).
- Analysis of patient demographics, ingested medications, clinical effects, and treatment outcomes.
Main Results:
- 93 pediatric cases (ages 1-16) were identified; 86% were under six years old.
- Chlorpropamide, glipizide, and glyburide accounted for 95% of ingestions.
- 27% of patients developed hypoglycemia (glucose < 60 mg/dL), with a mean minimum glucose of 46.5 mg/dL.
- Hypoglycemia onset ranged from 0.5 to 16 hours; 10% had persistent hypoglycemia despite IV glucose.
- Single tablet ingestions of chlorpropamide, glipizide, and glyburide caused hypoglycemia in young children.
- All patients recovered fully without neurological sequelae.
Conclusions:
- Children ingesting oral hypoglycemics require admission for 24-hour observation.
- Even small amounts, like a single tablet, can induce hypoglycemia in pediatric patients.
Background:
Oral hypoglycemic medications are frequently used for Type II diabetes and accidental ingestions by children may occur. There are no comprehensive pediatric studies documenting poison center experiences.
Study Objective:
To evaluate the toxicity of oral sulfonylurea ingestion in children and the efficacy of treatments instituted in these cases.
Method:
Retrospective review of all ingestions of oral sulfonylureas reported to a single regional poison control center 1987-1991.
Results:
Ninety-three cases were identified, one to 16 years old (mean of 3.5 years). Eighty cases (86%) were less than six years of age. Of the six medications used, three, chlorpropamide, glipizide and glyburide made up 88 (95%) cases. Twenty-five patients (27%) became hypoglycemic (glucose < 60 mg/dL). The mean minimum blood glucose in these patients was 46.5 mg/dL (minimum 20 mg/dL). Time of onset of hypoglycemia ranged from 0.5 to 16 h (mean 4.3 h; median 2 h). Only four patients had the onset of chemical hypoglycemia more than four hours postexposure. Persistent hypoglycemia occurred in nine children (10%) despite intravenous glucose therapy. There were no seizures. Mean time to decontamination of patients with and without hypoglycemia was 1.4 and 1.2 h respectively. Intravenous glucose of the following concentrations was administered: 5% (40), 10% (15), 20% (1), and 50% (3). Accidental ingestion of a single tablet of chlorpropamide (250 mg), glipizide (5 mg). and glyburide (2.5 mg) each produced hypoglycemia in children ages one to four years. Accidental ingestion of 5-10 mg glyburide produced a blood glucose of 57 mg/dL in an 11-year-old child. All patients recovered fully. There were no neurological sequelae noted.
Conclusion:
Children ingesting oral hypoglycemics should be admitted to a health care facility for 24 h observation. In this series a single tablet produced hypoglycemia.