Sulfonylurea toxicity

Background

• sulfonylureas are a commonly prescribed oral diabetes medication, and include glyburide, glimepiride, glipizide chlorpropamide, tolazamide
• inhibit potassium efflux from pancreatic beta cells--> increased insulin release

Management

Hypoglycemia from Sulfonylureas

Activated charcoal

• Administer activated charcoal, preferably within 1 hr of ingestion
• Multiple doses may be beneficial, especially for glipizide

Glucose Treatment

• Initial therapy regardless of known cause

Adults

• 50mL D50W bolus
• Start a D10 1/2NS drip (100mL/hr)

Children

• 1mL/kg of D50W OR
• 2mL/kg D25W OR 5-10mL/kg D10W
• Neonate: 5-10 mL/kg D10W

Octreotide

• Theoretical benefit to reduce risk of recurrent hypoglycemia
• Hyperpolarization of the beta cell results in inhibition of Ca influx and prevents insulin release
• 50-100 mcg subcutaneous in adults with repeat dosing Q6hrs
• 2 mcg/kg (max 150mcg) subcutaneously Q6hrs should be used in children
• Continuous infusion of 50-125 mcg/hr is an alternative in adults
• Administer octreotide for 24 hours, then after discontinuing, monitor for hypoglycemia for another 24 hours

Special Considerations

• Glucagon 5mg IM may be used as temporizing measure, e.g. while obtaining IV access
  • Dependent on glycogen stores which may be depleted in prolonged hypoglycemia
  • Also short duration of action
  • Caution in using glucagon drip
    • Glucagon also has an insulin-releasing effect
    • May subsequently cause initial paradoxical hypoglycemia

See Also

• Hypoglycemia