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Prospective multicenter study of sulfonylurea ingestion in children

H A Spiller1, D Villalobos, E P Krenzelok

  • 1Kentucky Regional Poison Center, Louisville 40232-5070, USA.

The Journal of Pediatrics
|July 1, 1997
PubMed

Insights

Pediatric sulfonylurea ingestions often do not cause symptoms. Monitoring for hypoglycemia (low blood glucose) within the first 8 hours after ingestion can safely predict a benign outcome in children.

Area of Science:

  • Pediatric Toxicology
  • Emergency Medicine
  • Clinical Pharmacology

Background:

  • Many pediatric sulfonylurea ingestions do not lead to adverse effects.
  • Over-admission of asymptomatic children results in unnecessary hospitalizations.

Purpose of the Study:

  • To prospectively identify predictors of symptomatic hypoglycemia in pediatric sulfonylurea ingestions.
  • To differentiate children at risk for hypoglycemia from those who will remain asymptomatic.

Main Methods:

  • Analysis of sulfonylurea exposures in children <= 12 years old across 10 poison centers.
  • Definition of hypoglycemia as blood glucose < 60 mg/dl.
  • Evaluation of clinical outcomes based on ingestion dose, time, and management strategies.

Main Results:

  • Hypoglycemia occurred in 30% of exposed children, typically within 8 hours.
  • Oral supplementation alone was sufficient for most patients; IV dextrose was needed for some.
  • Ingestion dose (<= 0.3 mg/kg vs > 0.3 mg/kg) was a significant predictor of hypoglycemia (p < 0.005).

Conclusions:

  • Absence of hypoglycemia within 8 hours predicts a benign outcome.
  • Clinical observation with oral feeding is a safe initial management strategy.
  • Dose-based management using mg/kg is currently inappropriate; focus on monitoring for hypoglycemia.
Abstract

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