Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Oral Hypoglycemic Agent Toxicity Differential Diagnoses

  • Author: David Tran, MD; Chief Editor: Timothy E Corden, MD  more...
 
Updated: Jul 14, 2015
 
 
 
Contributor Information and Disclosures
Author

David Tran, MD Attending Physician, Department of Emergency Medicine, North Shore-LIJ Plainview Hospital

David Tran, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Jeffrey R Tucker, MD Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Connecticut School of Medicine, Connecticut Children's Medical Center

Disclosure: Received salary from Merck for employment.

Chief Editor

Timothy E Corden, MD Associate Professor of Pediatrics, Co-Director, Policy Core, Injury Research Center, Medical College of Wisconsin; Associate Director, PICU, Children's Hospital of Wisconsin

Timothy E Corden, MD is a member of the following medical societies: American Academy of Pediatrics, Phi Beta Kappa, Society of Critical Care Medicine, Wisconsin Medical Society

Disclosure: Nothing to disclose.

Additional Contributors

Michael E Mullins, MD Assistant Professor, Division of Emergency Medicine, Washington University in St Louis School of Medicine; Attending Physician, Emergency Department, Barnes-Jewish Hospital

Michael E Mullins, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Emergency Physicians

Disclosure: Received stock ownership from Johnson & Johnson for none; Received stock ownership from Savient Pharmaceuticals for none.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author Michael Lucchesi, MD, to the original writing and development of this article.

References
  1. Hanchard B, Boulouffe C, Vanpee D. Sulfonylurea-induced hypoglycaemia: use of octreotide. Acta Clin Belg. 2009 Jan-Feb. 64(1):56-8. [Medline].

  2. Kane MP, Abu-Baker A, Busch RS. The utility of oral diabetes medications in type 2 diabetes of the young. Curr Diabetes Rev. 2005 Feb. 1(1):83-92. [Medline].

  3. Pearson ER. Pharmacogenetics in diabetes. Curr Diab Rep. 2009 Apr. 9(2):172-81. [Medline].

  4. Pasquel FJ, Klein R, Adigweme A, Hinedi Z, Coralli R, Pimentel JL, et al. Metformin-associated lactic acidosis. Am J Med Sci. 2015 Mar. 349 (3):263-7. [Medline].

  5. Mowry JB, Spyker DA, Cantilena LR Jr, McMillan N, Ford M. 2013 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 31st Annual Report. Clin Toxicol (Phila). 2014 Dec. 52 (10):1032-283. [Medline]. [Full Text].

  6. Mowry JB, Spyker DA, Cantilena LR Jr, Bailey JE, Ford M. 2012 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 30th Annual Report. Clin Toxicol (Phila). 2013 Dec. 51 (10):949-1229. [Medline]. [Full Text].

  7. Bronstein AC, Spyker DA, Cantilena LR Jr, Rumack BH, Dart RC. 2011 Annual report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 29th Annual Report. Clin Toxicol (Phila). 2012 Dec. 50 (10):911-1164. [Medline]. [Full Text].

  8. Bronstein AC, Spyker DA, Cantilena LR Jr, Green JL, Rumack BH, Dart RC. 2010 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 28th Annual Report. Clin Toxicol (Phila). 2011 Dec. 49 (10):910-41. [Medline]. [Full Text].

  9. Bronstein AC, Spyker DA, Cantilena LR Jr, Green JL, Rumack BH, Giffin SL. 2009 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 27th Annual Report. Clin Toxicol (Phila). 2010 Dec. 48 (10):979-1178. [Medline]. [Full Text].

  10. Bronstein AC, Spyker DA, Cantilena LR Jr, Green JL, Rumack BH, Giffin SL. 2008 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 26th Annual Report. Clin Toxicol (Phila). 2009 Dec. 47 (10):911-1084. [Medline]. [Full Text].

  11. Bronstein AC, Spyker DA, Cantilena LR Jr, Green JL, Rumack BH, Heard SE, et al. 2007 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 25th Annual Report. Clin Toxicol (Phila). 2008 Dec. 46 (10):927-1057. [Medline]. [Full Text].

  12. Bronstein AC, Spyker DA, Cantilena LR Jr, Green JL, Rumack BH, Heard SE, et al. 2007 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 25th Annual Report. Clin Toxicol (Phila). 2008 Dec. 46 (10):927-1057. [Medline]. [Full Text].

  13. Bronstein AC, Spyker DA, Cantilena LR Jr, Green J, Rumack BH, Heard SE. 2006 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS). Clin Toxicol (Phila). 2007 Dec. 45 (8):815-917. [Medline]. [Full Text].

  14. Levine M, Ruha AM, Lovecchio F, et al. Hypoglycemia after accidental pediatric sulfonylurea ingestions. Pediatr Emerg Care. 2011 Sep. 27(9):846-9. [Medline].

  15. Furukawa S, Kumagi T, Miyake T, Ueda T, Niiya T, Nishino K, et al. Suicide attempt by an overdose of sitagliptin, an oral hypoglycemic agent: a case report and a review of the literature. Endocr J. 2012. 59(4):329-33. [Medline].

  16. Adam PA, Schwartz R. Diagnosis and treatment: should oral hypoglycemic agents be used in pediatric and pregnant patients?. Pediatrics. 1968 Nov. 42(5):819-23. [Medline].

  17. Boyle PJ, Justice K, Krentz AJ, et al. Octreotide reverses hyperinsulinemia and prevents hypoglycemia induced by sulfonylurea overdoses. J Clin Endocrinol Metab. 1993 Mar. 76(3):752-6. [Medline].

  18. Braatvedt GD. Octreotide for the treatment of sulphonylurea induced hypoglycaemia in type 2 diabetes. N Z Med J. 1997 May 23. 110(1044):189-90. [Medline].

  19. Ferner RE, Chaplin S. The relationship between the pharmacokinetics and pharmacodynamic effects of oral hypoglycaemic drugs. Clin Pharmacokinet. 1987 Jun. 12(6):379-401. [Medline].

  20. Gjedde S, Christiansen A, Pedersen SB, Rungby J. Survival following a metformin overdose of 63 g: a case report. Pharmacol Toxicol. 2003 Aug. 93(2):98-9. [Medline].

  21. Goldfrank LR, Flomenbaum NE, Lewin NA, eds. Goldfrank's Toxicologic Emergencies. McGraw-Hill Professional Publishing; 1988. 671-87.

  22. Gul M, Cander B, Girisgin S, Ayan M, Kocak S, Unlu A. The effectiveness of various doses of octreotide for sulfonylurea-induced hypoglycemia after overdose. Adv Ther. 2006 Nov-Dec. 23(6):878-84. [Medline].

  23. Haymond MW. Hypoglycemia in infants and children. Endocrinol Metab Clin North Am. 1989 Mar. 18(1):211-52. [Medline].

  24. Johnson SF, Schade DS, Peake GT. Chlorpropamide-induced hypoglycemia: successful treatment with diazoxide. Am J Med. 1977 Nov. 63(5):799-804. [Medline].

  25. Little GL, Boniface KS. Are one or two dangerous? Sulfonylurea exposure in toddlers. Journal of Emergency Medicine. 2005. 28:305-10. [Medline].

  26. Pavone L, Mollica F, Musumeci S, et al. Accidental glibenclamide ingestion in an infant: clinical and electroencephalographic aspects. Dev Med Child Neurol. 1980 Jun. 22(3):366-71. [Medline].

  27. Ramos E, Baron S, Sentanac S. Hypoglycemia associated with oral sulfonylurea hypoglycemic agents in an 11-year-old girl. Archives de Pediatrie. 2005. 12:1109-11. [Medline].

  28. Rao NG, Menezes RG, Nagesh KR, Kamath GS. Suicide by combined insulin and glipizide overdose in a non-insulin dependent diabetes mellitus physician: a case report. Med Sci Law. 2006 Jul. 46(3):263-9. [Medline].

  29. Rowden AK, Fasano CJ. Emergency management of oral hypoglycemic drug toxicity. Emerg Med Clin North Am. 2007 May. 25(2):347-56; abstract viii. [Medline].

  30. Sarmah AK, Sabadie J. Hydrolysis of sulfonylurea herbicides in soils and aqueous solutions: a review. J Agric Food Chem. 2002 Oct 23. 50(22):6253-65. [Medline].

  31. Soderstrom J, Murray L, Daly FF, Little M. Toxicology case of the month: oral hypoglycaemic overdose. Emerg Med J. 2006 Jul. 23(7):565-7. [Medline].

  32. Spiller HA. Management of sulfonylurea ingestions. Pediatr Emerg Care. 1999 Jun. 15(3):227-30. [Medline].

  33. Spiller HA, Sawyer TS. Toxicology of oral antidiabetic medications. Am J Health Syst Pharm. 2006 May 15. 63(10):929-38. [Medline].

  34. Spiller HA, Schroeder SL, Ching DS. Hemiparesis and altered mental status in a child after glyburide ingestion. J Emerg Med. 1998 May-Jun. 16(3):433-5. [Medline].

  35. Spiller HA, Villalobos D, Krenzelok EP, et al. Prospective multicenter study of sulfonylurea ingestion in children. J Pediatr. 1997 Jul. 131(1 Pt 1):141-6. [Medline].

  36. Szlatenyi CS, Capes KF, Wang RY. Delayed hypoglycemia in a child after ingestion of a single glipizide tablet. Ann Emerg Med. 1998 Jun. 31(6):773-6. [Medline].

  37. Trenque T, Hoizey G, Lamiable D. Serious Hypoglycemia: Munchausen's Syndrome?. Diabetes Care. 2001. 24:792-3.

Previous
Next
 
Normal hypoglycemic counterregulation.
Table. Sulfonylurea exposures reported to the American Association of Poison Control Centers' National Data Collection System from 2006-2013
YearExposures<6 Years≥6 YearsUnintentional ExposuresOverall Mortality*Pediatric Mortality
20061951974903164710
20071975991890166600
20081850987808157100
20091769922769151510
20101712898745145300
2011168780480714041†-
2012175385079814491†-
20131590778762134000
Total14,2877204648212,04540
*Overall mortality includes adult and pediatric cases † Patient age not noted
Previous
Next
 
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.