Sulfonylureas overdose

Boyle PJ, Justice K, Krentz AJ, Nagy RJ, Schade DS. Octreotide reverses hyperinsulinemia and prevents hypoglycemia induced by sulfonylurea overdoses. J Clin Endocrinol Metab 1993 76(3) 752-6. 

Palatnick W, Meatherall RC, and Tenenbein M (1991) Clinical spectrum of sulfonylurea overdose and experience with diazoxide therapy. Archives of Internal Medicine 151 1859-1862. 

A. Oral sulfonylurea overdose. Give 50-100 meg (children 4-5 meg/kg/day divided every 6 hours) by subcutaneous or intravenous injection once or every 6 to 12 hours as needed (some sulfonylurea poisonings may require days of therapy). Infusions up to 125 meg/h have been used (see note below). May need to monitor for recurrent hypoglycemia tor 24 hours after termination of octreotide therapy. 

Treatment of sulfonylurea-induced hypoglycemia and of overdose with sulfonylureas has been reviewed (69). If intravenous dextrose is insufficient, octreotide is recommended (70) but not diazoxide. In patients with insulin reserve, dextrose can stimulate insulin secretion and paradoxically worsen the condition. Patients with drug-induced hypoglycemia should not be given glucagon, since it will stimulate insulin secretion. Hypoglycemia can last for up to 5 days. Continued observation is important, because recurrence after temporary recovery is common. 

While biguanides, alpha-glucosidase inhibitors, and glitazones are not likely to cause hypoglycemia after acute overdose, they may contribute to the hypoglycemic effects of sulfonylureas, meglitinides, or Insulin. 

IV. Diagnosis. Overdose involving a sulfonylurea, meglitinide, or insulin should be... 

For patients with a sulfonylurea or meglitinide overdose, consider intravenous octreotide (see p 480) or diazoxide (p 433) if 5% dextrose infusions do not maintain satisfactory glucose concentrations. 

---