A 3 years old boy brought by his family 30 min after ingesting one tablet of his grandma medication
On arrival,he is playful and active , normal vitals and blood sugar 6 mmol/l. Your junoir want to give me dextrose infusion for 2 hours then discharge him home.
Grandma Pill Cont’ Thanks all for your excellent comments Many of the sulfonylureas have long durations of action, which explains the unusually long period of hypoglycemia that occurs in both therapeutic use and overdose. Second-generation sulfonylureas (glimepiride, glipizide, glyburide) have half-lives that approach 24 hours.The sulfonylureas frequently cause hypoglycemia which could have delayed onset following overdose. In a prospective poison control center study of sulfonylurea exposures in children, 56 of 185 (30%) patients developed hypoglycemia, with a time of onset ranging from 1 to 21 hours and a mean of 5.3 hours Management : *AC is recommended if no contraindication *Children who unintentionally ingest one or more sulfonylurea tablets should generally be hospitalized for 24 hours observation *Symptomatic patients with hypoglycemia require immediate treatment with 0.5 to 1 g/kg hypertonic intravenous dextrose in the form of D50W in adults, D25W in children, and D10W in neonates.
*Octreotide is recommended for recurrent hypoglycemia *Asymptomatic children are best managed without prophylactic intravenous dextrose, which could contribute to delayed onset of hypoglycemia. Elevations in glucose concentrations stimulate insulin release by the pancreas. Such patients instead are best managed by early feeding, frequent checks of glucose concentrations, and observation of mental status. References 1- Goldfrank’s Toxic logic Emergencies 11th edition 2.Hypoglycemia in Pediatric Sulfonylurea Poisoning: An 8-Year Poison Center Retrospective Study.Derrick D. Lung and Kent R. OlsonPediatrics June 2011, 127 (6) e1558-e1564; DOI: https://doi.org/10.1542/peds.2010-3235