Oral Hypoglycemic Agent Toxicity Workup

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

Laboratory Studies

Most hospitals do not have the capability to analyze for levels of sulfonylureas and/or their metabolites. Even if it is possible to obtain these levels, no data indicate they should be used in the clinical setting. Tests for oral hypoglycemic agent exposure may include the following:

  • Fingerstick and/or serum glucose test to detect hypoglycemia (If hypoglycemia does not occur within the first 2-4 hours after suspected ingestion/overdose, then other laboratory tests are unnecessary.)
  • Baseline CBC count (in symptomatic patients)
  • Baseline electrolytes, especially potassium (in symptomatic patients)
  • Serum aspirin and acetaminophen concentrations, and urine toxicological screening, if intentional ingestion/suicide attempt is suspected
  • Pregnancy test, if indicated
  • Ethanol level, if indicated
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Imaging Studies

  • Head CT scanning without, and then with, intravenous contrast is recommended in patients with an altered mental status, a focal neurologic defect, or new-onset seizures.
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Other Tests

  • Electrocardiography (ECG) is recommended in patients with a suspected history of tricyclic antidepressant toxicity, which can reveal QRS prolongation, or in cases of severe electrolyte abnormalities.
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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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