Oral Hypoglycemic Agent Toxicity Treatment & Management

  • Author: David Tran, MD; Chief Editor: Timothy E Corden, MD   more...
 
Updated: Sep 30, 2011
 

Medical Care

  • Prehospital care
    • The main goal in oral hypoglycemic agent exposure is supportive care, which includes airway, breathing, and circulation.
    • Intravenous administration of glucose rapidly resolves the effects of hypoglycemia. Its onset is quicker than oral administration of sugar, and it is safer in patients with a depressed mental status who should not take anything by mouth for fear of aspiration. Glucagon is helpful and can be administered intravenously, intramuscularly, or subcutaneously. Glucagon is particularly useful in the intramuscular mode when intravenous access cannot be obtained immediately.
  • Emergency department care
    • Generally, all symptomatic patients who present with hypoglycemia need admission to the hospital in a monitored setting. Patients who remain asymptomatic and who do not develop hypoglycemia in the first 8-12 hours may be discharged safely home. However, the data from one study suggest that because accidental ingestion of sulfonylurea results in delayed and often prolonged hypoglycemia, admission for at least 16 hours is recommended, with frequent glucose monitoring.[15]
    • At minimum, patients need intravenous access. If a patient is lethargic, then oxygen, continuous cardiac monitoring, and pulse oximeter are indicated. Until the patient totally regains mental status, do not administer anything by mouth.
    • Administer intravenous glucose to all pediatric patients with hypoglycemic symptoms. Depending on the amount of the drug and its half-life, patients may require intravenous glucose administration for anywhere from several hours to several days. If patients do not respond to continuous glucose administration with supplemental boluses, then octreotide or diazoxide can be administered.
    • Ipecac is not recommended because of the possibility of aspiration in patients with a depressed mental status.
    • Administer activated charcoal as soon as possible, preferably within 1 hour of ingestion; however, most unintentional pediatric exposure results in ingestion of 1 or 2 tablets of sulfonylureas. No data indicate that gastric lavage or administration of activated charcoal has any benefit in these cases.
    • Multiple doses of activated charcoal have been suggested in patients with glipizide overdose because this hypoglycemic agent has an enterohepatic circulation.
    • Hemodialysis is not indicated because most sulfonylureas have high protein binding.
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Consultations

  • Contact a regional poison control center for assistance.
  • Consult a psychiatrist for all suicidal cases.
  • Notify the Department of Social Services of suicide attempts as well as cases of possible neglect and inappropriate supervision.
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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 and American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

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 and American College of Emergency Physicians

Disclosure: Johnson & Johnson stock ownership None; Savient Pharmaceuticals stock ownership None

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: Merck Salary Employment

Paul D Petry, DO, FACOP, FAAP  Consulting Staff, Freeman Pediatric Care, Freeman Health System

Paul D Petry, DO, FACOP, FAAP is a member of the following medical societies: American Academy of Osteopathy, American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association

Disclosure: Nothing to disclose.

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, and Wisconsin Medical Society

Disclosure: Nothing to disclose.

Additional Contributors

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

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Normal hypoglycemic counterregulation.
Table. The American Association of Poison Control Centers' National Data Collection System from 1989-1997
YearExposures< 6 Years6-19 YearsUnintentional ExposuresOverall Mortality*Pediatric Mortality
19891467808† 130113910
19901601910† 120126511
199120131143† 158157730
199223411310† 143182420
199322721207180179410
199424821246192194581
199528151381230221430
199633331468276259440
199738461619370303341
Total2217011092179917385273
*Overall mortality includes adult and pediatric cases



† Denotes patients aged 6-17 years



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