Citation

Gul M, Cander B, Ak A, Sadik Girişgin A, Bayir A, Kocak S. Turk. Klin. J. Med. Sci. 2008; 28(1): 100-103.

Copyright

(Copyright © 2008, Hekimler Birliği Vakfı)

DOI

unavailable

PMID

unavailable

Abstract

Patients who present to the emergency department after ingestion of excessive amounts of suflonylurea medications have hypoglycemia refractory to dextrose administration. Recently, the use of octreotide was described as an alternative treatment in such patients. A diabetic patient with chronic renal failure who ingested excessive amounts of sulfonylurea medications causing refractory hypoglycemia resistant to treatment with large doses of intravenous dextrose was presented here. Octreotide administration rapidly reversed hypoglycemia allowing the patient's stabilization and eventual discharge without any significant adverse events. We believe that octreotide may be an effective therapy in refractory sulfonylurea-induced hypoglycemia. Copyright © 2008 by Türkiye Klinikleri.; Results:Following Sandostatin administration, there was prompt improvement in the blood sugar level, with abolition of hypoglycemic episodes. His blood sugar normalized and intravenous 10% dextrose infusion was stopped over the next 8 hours. Once he started to tolerate oral feeding, he was discharged in good condition. In addition to at least 2 meals and oral dextrose supplementation, the patient had received a total of 2400 mL (240 grams) of 10% dextrose before stabilization with Sandostatin. Psychiatric evaluation showed no indication for inpatient care, and follow up with the psychiatric service was arranged. He later agreed to receive hemodialysis, and continued to receive maintenance hemodialysis. The C-peptide levels which were initially high, were suppressed.; AdverseEffects:No adverse events occurred.; AuthorsConclusions:Based on our case report and previous reports, we suggest that octreotide should be considered for first-line therapy in the treatment of hypoglycemia secondary to SU overdose in diabetic patients with CRF. All patients must be carefully monitored for recurrent hypoglycemia during octreotide therapy and for perhaps 24 hours following termination of octreotide therapy before discharge. Continuing research is required to better define the optimal dose, dosing interval, and inpatient monitoring requirements.; FreeText:The patient ingested 2400 mg of gliclazide causing refractory hypoglycemia resistant to treatment with intravenous dextrose. He had history of attempting suicide after ingesting 30 tablets (80 mg tablet) of gliclazide (approximately 2400 mg) less than 4 hours previously was admitted to the emergency department (ED). He had 2 more episodes of hypoglycemia over the next 4 hours until arriving ED. On admission his blood pressure was 130/70 mmHg. The heart rate was 90 beats/minute, respiratory rate 24/minute and axillary temperature 36.8°Celsius. Finger prick glucose recorded 10 mm after admission was 40 mg/dL (glucose measurements were obtained using a calibrated bedside glucometer). He was noted to be tremulous and diaphoretic but was alert and oriented. He was commenced on intravenous 10% dextrose at 100 cc/hour. He continued to have recurrent hypoglycemia not responsive to repeated administration of intravenous 10% dextrose. Approximately 8 hours after admission, the measured glucose did not improve to greater than 75 mg/dL. After 16 hours in the ED and with recurrent hypoglycemia, he was given Sandostatin along with intravenous 10% dextrose for a finger prick glucose of 50 mg/dL. Outcome measure: C-peptide levels by radioimmunoassay to assess the impact on insulin release. Concomitant treatment: intravenous 10% dextrose.; Indications:1 patient with prolonged sulfonylurea-induced hypoglycemia. Coexisting disease: chronic renal failure, diabetes.; Patients:One 46-year-old male inpatient.; TypeofStudy:A case report describing the successful treatment of prolonged sulfonylurea (SU)-induced hypoglycemia with Sandostatin in a patient with chronic renal failure (CRF).; DosageDuration:50 mcg sc. Duration not stated.

Language: en

Keywords

adult; human; male; case report; drug overdose; Hypoglycemia; article; emergency treatment; drug efficacy; glucose; glibenclamide; hypoglycemia; non insulin dependent diabetes mellitus; glucagon; octreotide; Octreotide; sulfonylurea; glipizide; chronic kidney failure; sustained release formulation; glimepiride; diazoxide; gliclazide; Kidney failure, chronic; Sulfonylurea receptor