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Hemiparesis and altered mental status in a child after glyburide ingestion
H A Spiller1, S L Schroeder, D S Ching
1Kentucky Regional Poison Center, Louisville 40232-5070, USA.
Insights
A 6-year-old experienced severe hypoglycemia and neurological deficits after ingesting glyburide, a diabetes medication. Prompt medical intervention with intravenous glucose successfully resolved the symptoms, highlighting the importance of early evaluation for pediatric glyburide ingestion.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Toxicology
- Endocrinology
Background:
- Accidental ingestion of oral hypoglycemic agents in children can lead to severe hypoglycemia.
- Glyburide, a second-generation sulfonylurea, poses a significant risk due to its potency and long duration of action.
Observation:
- A previously healthy 6-year-old presented with agitation, lethargy, and hemiparesis following suspected ingestion of glyburide tablets.
- Initial blood glucose was critically low (34 mg/dL), with neurological deficits including unresponsiveness and asymmetric motor function.
- Ophthalmological examination revealed equal, reactive pupils and leftward eye deviation.
Findings:
- Despite initial glucose administration, the patient required continuous intravenous glucose infusion (4 mg/kg/min) to maintain blood glucose above 74 mg/dL.
- Neurological deficits, including hemiparesis and altered mental status, resolved completely within 48 hours.
- The clinical presentation was consistent with a hypoglycemia-induced seizure followed by Todd's paralysis.
Implications:
- This case underscores the potential for severe toxicity from even small amounts of glyburide in children.
- Early and aggressive glucose management, including continuous intravenous infusion, is crucial for treating glyburide-induced hypoglycemia.
- Prompt medical evaluation and toxicology screening are recommended for all suspected pediatric ingestions of sulfonylureas.
Abstract:
A normally healthy 6-year-old woke in an agitated state, limp, and moving only her left extremities. Upon arrival at the emergency department, a blood glucose measurement was 34 mg/dL. The child was lethargic, not responding to questions appropriately, and not moving her right extremities. The right arm was flexed, and the right leg was flexed and abducted. Pupils were equal and reactive, and eyes were deviated to the left. Six loose tablets of the grandmother's glyburide were found at home in the child's outdoor playhouse. Administration of glucose produced no change in the child's clinical condition. Intravenous glucose was begun at 4 mg glucose/kg/min, and the blood glucose level did not fall below 74 mg/dL after that. Over the next 48 h, the hemiparesis and mental status changes resolved without sequelae. The events of the case suggest a hypoglycemia-induced seizure with subsequent Todd's paralysis. Early direct medical evaluation in suspected glyburide ingestions in children is suggested.