SULFONYLUREA INTOXICATION AT A TERTIARY CARE PAEDIATRIC HOSPITAL
Main Article Content
Keywords
Sulfanylurea, glyburide, chlorpropamide, poisoning, toxicity, children
Abstract
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 2001and 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.
References
2. Abrahamsson H. Direct measurement of increased free cytoplasmic Ca2+ in mouse pancreatic B-cells following stimulation by hypoglycemic sulphonylureas. FEBS Lett 1985;190:21-4.
3. Gerich JE. Oral hypoglycemic agents. N Engl J Med 1989;321:1231-45.
4. Harrigan RA, Nathan MS, Beattie P. Oral agents for the treatment of type 2 diabetes mellitus: pharmacology, toxicity, and treatment. Ann Emerg Med 2001;38:68-78.
5. Litovitz TL, Klein Scwartz W, Dyer KS, et al. 1997 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med 1998;16(5):443-7.
6. Selam JL. Pharmacokinetics of hypoglycemic sulfonamides: Ozidia, a new concept. Diabetes Metab 1997;23 Supl 4:39-43.
7. AHFS Drug Information. American Hospital Formulary Service Board of the American Society of Health System Pharmacists 1998;68:2595-7.
8. Szlatenyi CS, Capes KF, Wang RY. Delayed hypoglycemia in a child after ingestion of a single glipizide table. Annals of Emerg Medicine June 1998;31(6):773-6.
9. Hussain K, Mundi H, Aynsley-Green A, Champion M. A child presenting with disordered consciousness, hallucinations, screaming episodes and abdominal pain. Eur J Pediatr 2002;161(2):127-9.
10. Pavone L, Mollica F, Musumeci S, Marino S, Pampigloine G. Accidental Ingestion in an infant, clinical and electroencephalographic aspects. Dev Med Child Neurol 1980;22:366-71.
11. Spiller HA. Management of sulfonylurea ingestions. Pediatr Emerg Care 1999;15(3):227-30.
12. Graudins A, Linden CH, Ferm RP. Diagnosis and treatment of sulphonylurea-induced hyperinsulinaemic hypoglycemia. Am J Emerg Med 1997;15:95-6.
13. Johnson SF, Schade DS, Peake GT. Chlorpropamideinduced hypoglycemia: successful treatment with diazoxide. Am J Med 1977;63:799-804.
14. Lhereux PE, Zahir S, Penaloza A, Gris M. Benchto- bedside review: Antidotal treatment of sulphonylurea-induced hypoglycaemia with octreotide. Critical Care 2005;9:543-9.
15. McLaughlin SA, Crandall CS, McKinney PE. Octreotide: an antidote for sulphonylurea-induced hypoglycemia. Ann Emerg Med 2000;36:133–8.
16. Matteucci MJ. One pill can kill: assessing the potential for fatal poisoning in children. Pediatr Ann. 2005 Dec;34(12):964.
17. Bar-oz B, Levichek Z, Koren G. Medication that can be fatal for a toddler with one tablet or teaspoonful: a 2004 update. Paediatr Drugs 2004:6(2):123-6.
18. Haymond MW. Hypoglycemia in infants and children. Endocrinol Metab Clin Nort Am 1989;18:211-52.
19. Spiller HA, Schoeder SL, Ching DS. Hemiparesis and altered mental status in a child after glyburide ingestion. J Emerg Med 1998 May-Jun;16(3):433- 5.
20. Burkhart KK. When does hypoglycemia develop after sulfonylurea ingestion? Ann Emerg Med 1998;31:771-772.
20. Borowski H, Caraccio T, Mofenson H. Sulfonylurea ingestion in children is an 8-hour observation period sufficient? J Pediatr 1998;133(4):584-5.
21. Kannisto H, Neuvonen PJ. Absorption of sulfonylureas onto activated charcoal in vitro. J Pharma Sci 1984;73:253-5.
22. Rath S, Bar-Zeev N, Anderson K, Fahy R, Roseby R. Octreotide in children with hypoglycaemia due to sulfonylurea ingestion. J Paedtr Child Health 2008;44(6):383-4.
23. Betten DP, Vohra RB, Cook MD, Matteucci MJ, Clark RF. Antidote use in the critically ill poisoned patient. J Intensive Care Med 2006;21(5):255-77.
24. Carr R, Zed PJ. Octreotide for sulfonylureainduced hypoglycemia following overdose. Ann Pharmacother 2002;36(11):1727-32.
25. Glaser B, Hirsch HJ, Landau H. Persistent hyperinsulinaemic hypoglycemia of infancy: longterm octreotide treatment without pancreatectomy. J Pediatr 1993;123(4):644–50.
26. Kent DA, Main BA, Friesen MS. Use of octreotide in sulphonylurea poisoning in a child. J Toxicol Clin Toxicol 2003;41:669.
27. Pelavin PI, Abramson E, Pon S, Vogiatzi MG. Extended-release glipizide overdose presenting with delayed hypoglycemia and treated with subcutaneous octreotide. J Pediatr Endocrinol Metab 2009;22(2):171-5.