History

A single tablet of sulfonylurea (eg, a glipizide 5-mg tablet) may produce hypoglycemia in a child. Glipizide has been reported to produce hypoglycemia within 5 minutes of ingestion in an adult. Patients usually become symptomatic within 2 hours of ingestion. Symptoms of hypoglycemia may be delayed if food is taken with the oral hypoglycemic agents. Symptoms may include the following:

Lethargy
Confusion
Irritability
Unresponsiveness
Dizziness
Headache
Blurred vision
Psychotic behavior
Emesis
Delirium
Feeding difficulties

Physical Examination

Patient presentation depends on the severity and duration of hypoglycemia. In the nondiabetic individual, signs and symptoms of hypoglycemia may not occur until serum glucose drops below 40 mg/dL. Signs may include the following:

Altered mental status
Generalized weakness
Diaphoresis
Tachycardia
Tachypnea
Transient neurologic deficit
Pallor
Seizure
Cyanosis
Coma
Hypothermia
Athetotic movement

Differential Diagnoses

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Normal hypoglycemic counterregulation.

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Table. Sulfonylurea exposures reported to the American Association of Poison Control Centers' National Data Collection System from 2006-2021

Table. Sulfonylurea exposures reported to the American Association of Poison Control Centers' National Data Collection System from 2006-2021

Year	Exposures	< 6 Years	≥6 Years	Unintentional Exposures	Overall Mortality*	Pediatric Mortality
2006	1951	974	903	1647	1	0
2007	1975	991	890	1666	0	0
2008	1850	987	808	1571	0	0
2009	1769	922	769	1515	1	0
2010	1712	898	745	1453	0	0
2011	1687	804	807	1404	1†	-
2012	1753	850	798	1449	1†	-
2013	1590	778	762	1340	0	0
2014	1584	778	769	1316	2	0
2015	1659	807	852	1413	2	0
2016	1582	677	905	1295	2†	-
2017	1471	693	778	1240	2†	-
2018	1512	613	899	1199	1†
2019	1370	570	800	1113	0
2020	1189	482	707	957	1†
2021	1084	410	674	844	2†
*Overall mortality includes adult and pediatric cases † Patient age not noted

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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

Stephen L Thornton, MD Associate Clinical Professor, Department of Emergency Medicine (Medical Toxicology), University of Kansas Hospital; Medical Director, University of Kansas Hospital Poison Control Center; Staff Medical Toxicologist, Children’s Mercy Hospital

Stephen L Thornton, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Emergency Physicians, American College of Medical Toxicology

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.

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.

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.