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Abstract
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BACKGROUND: Unintentional poisoning with sulfonylurea hypoglycaemic drugs is a serious danger to infants and children, as the ingestion of relatively small amounts can be fatal. Although the administration of octreotide is considered effective in patients that remain hypoglycaemic despite glucose administration, experience in children is limited.
METHODS: A retrospective chart review of the clinical features of all children following sulfonylurea ingestion presenting between April 2001 and November 2008 at the Hospital for Sick Children in Toronto.
RESULTS: Ten children were identified with sulfonylurea exposure; six were classified as suspected ingestion and four had confirmed signs of sulfonylurea overdoses (mean age: 8.2 years; range 1.5 - 15). All four patients with confirmed ingestion were exposed to glyburide and developed severe hypoglycaemia; two were toddlers and two teenagers. Ingestion was accidental in the case of the toddlers, and suicidal attempts in the case of the adolescents. All patients were initially treated with glucose infusions. Both toddlers also received octreotide with favourable response and no rebound hypoglyacemia. The two teenagers were treated only with prolonged glucose infusions; in both cases rebound hypoglycaemia and increased glucose requirements were observed.
DISCUSSION: Glyburide-induced hypoglycaemia was pronounced in all patients identified. Treatment with octreotide proved effective in the 2 infants treated, agreeing with the limited experience reported to date in the literature, and suggesting that octreotide should be considered the treatment of choice in children. © 2010 Canadian Society of Pharmacology and Therapeutics. All rights reserved.; Indications:2 patients with sulfonylurea (glyburide)-intoxication characterized by refractory hypoglycemia.; Patients:2 patients, both boys, aged 18 months and 2 years.; AuthorsConclusions:The use of octreotide appears to reduce hypoglycemia and glucose requirements in sulfonylurea overdose, with no significant toxicities described to date. Clinical experience suggests that octreotide is effective in treating sulfonylurea-induced prolonged or refractory hypoglycemia in children. These findings require confirmation by larger pediatric studies; but, given the sporadic nature of pediatric sulfonylureas intoxication, it is unlikely that such a study will be performed in the near future. In light of the safety and effectiveness of octreotide in adults and the limited pediatric cases reported to date, we believe that this drug should be considered the treatment of choice for pediatric sulfonylurea intoxication. At the same time, we would urge physicians who apply this treatment in children to report their experiences, in particular adverse reactions potentially associated to octreotide, to help accumulate evidence on this drugs' safety in the pediatric population.; TypeofStudy:Cases describing sulfonylurea (glyburide)-intoxication, characterized by refractory hypoglycemia, successfully treated with Sandostatin in 2 pediatric patients in tertiary care hospital.; DosageDuration:Patient 1: 2 mcg/kg as sc bolus injection. Duration: single dose. Patient 2: 1 mcg/kg iv. Duration: 2 doses 6 hours apart.; Results:In the first case, blood glucose was 5.7 mmol/l (103 mg/dl) 2 hours after Sandostatin administration and remained stable for the rest of the observation period with no further symptoms of hypoglycemia. In the second case, blood glucose level remained over 5 mmol/l after the first Sandostatin dose. No further complications were observed.; AdverseEffects:No adverse events were mentioned.; FreeText:Case 1: The patient presented with drowsiness but responsive to voice, irritability, and glucometer blood glucose of 2.2 mmol/l (40 mg/dl) after accidental ingestion of glyburide 5 mg (10 tablets). A 1 ml/kg intravenous bolus of 10 % dextrose was given and infusion of 5% dextrose at 50 ml/hour was commenced but patient's blood glucose was 3.6 mmol/l (65 mg/dl). After the patient required 2 additional glucose boluses, Sandostatin was administered. Case 2: The second patient was irritable, thirsty, and had a seizure after accidental ingestion of glyburide pills. Blood glucose was 1.3 mmol/l (24 mg/dl), and intravenous 50% dextrose was given. After the second episode of seizure, another 10% dextrose was administered. Sandostatin treatment was initiated.
Language: en |