Template:Sulfonylurea Toxicity: Difference between revisions
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eds: Goldfrank’s Toxicologic Emergencies. New York NY, 2006;770-773</ref>=== | eds: Goldfrank’s Toxicologic Emergencies. New York NY, 2006;770-773</ref>=== | ||
====Activated | ====[[Activated charcoal]]<ref>Tran D et al. Oral Hypoglycemic Agent Toxicity Treatment & Management. Jul 14, 2015. http://emedicine.medscape.com/article/1010629-treatment#showall.</ref>==== | ||
*Administer activated charcoal, preferably within 1 hr of ingestion | *Administer activated charcoal, preferably within 1 hr of ingestion | ||
*Multiple doses may be beneficial, especially for glipizide | *Multiple doses may be beneficial, especially for glipizide | ||
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;Adults: | ;Adults: | ||
*50mL D50W bolus | *50mL [[D50W]] bolus | ||
*Start a D10 1/2NS drip (100mL/hr) | *Start a D10 1/2NS drip (100mL/hr) | ||
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*Neonate: 5-10 mL/kg D10W | *Neonate: 5-10 mL/kg D10W | ||
====Octreotide<ref>Fasano CJ et al. Comparison of Octreotide and standard therapy versus standard therapy alone for the treatment of sulfonylurea-induced hypoglycemia. Ann Emerg Med 2008; 51:400-406</ref>==== | ====[[Octreotide]]<ref>Fasano CJ et al. Comparison of Octreotide and standard therapy versus standard therapy alone for the treatment of sulfonylurea-induced hypoglycemia. Ann Emerg Med 2008; 51:400-406</ref>==== | ||
*Theoretical benefit to reduce risk of recurrent hypoglycemia | *Theoretical benefit to reduce risk of recurrent hypoglycemia | ||
*Hyperpolarization of the beta cell results in inhibition of Ca influx and prevents insulin release | *Hyperpolarization of the beta cell results in inhibition of Ca influx and prevents insulin release | ||
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====Special Considerations==== | ====Special Considerations==== | ||
*Caution in using [[glucagon]] drip | *Caution in using [[glucagon]] drip | ||
**Glucagon also has an insulin-releasing effect | **[[Glucagon]] also has an insulin-releasing effect | ||
**May subsequently cause initial paradoxical hypoglycemia | **May subsequently cause initial paradoxical hypoglycemia | ||
Revision as of 07:54, 9 June 2016
Hypoglycemia from Sulfonylureas[1][2]
Activated charcoal[3]
- 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[4]
- Theoretical benefit to reduce risk of recurrent hypoglycemia
- Hyperpolarization of the beta cell results in inhibition of Ca influx and prevents insulin release
- May be effective in:
- Sulfonylurea toxicity
- Insulinoma - up to 50% of pts may benefit[5]
- 50-100 mcg subcutaneous in adults with repeat dosing Q6hrs
- 2 mcg/kg (max 150mcg) subcutaneously should be used in children
- Continuous infusion of 50-125 mcg/hr is an alternative in adults
Special Considerations
- Caution in using glucagon drip
- Glucagon also has an insulin-releasing effect
- May subsequently cause initial paradoxical hypoglycemia
- ↑ Rowden AK, Fasano CJ. Emergency management of oral hypoglycemic drug toxicity. Emerg Med Clin N Am 2007; 25:347-356
- ↑ Howland MA. Antidotes in Depth: Octreotide. In: Flomenbaum NE, Goldfrank LR, Hoffman RS et al, eds: Goldfrank’s Toxicologic Emergencies. New York NY, 2006;770-773
- ↑ Tran D et al. Oral Hypoglycemic Agent Toxicity Treatment & Management. Jul 14, 2015. http://emedicine.medscape.com/article/1010629-treatment#showall.
- ↑ Fasano CJ et al. Comparison of Octreotide and standard therapy versus standard therapy alone for the treatment of sulfonylurea-induced hypoglycemia. Ann Emerg Med 2008; 51:400-406
- ↑ Arnold R, Simon B, Wied M. Treatment of neuroendocrine GEP tumours with somatostatin analogues: a review. Digestion. 2000. 62 Suppl 1:84-91.