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

Hanchard B, Boulouffe C, Vanpee D. Sulfonylurea-induced hypoglycaemia: use of octreotide. Acta Clin Belg. 2009 Jan-Feb. 64(1):56-8. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Pearson ER. Pharmacogenetics in diabetes. Curr Diab Rep. 2009 Apr. 9(2):172-81. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Klein-Schwartz W, Stassinos GL, Isbister GK. Treatment of sulfonylurea and insulin overdose. Br J Clin Pharmacol. 2016 Mar. 81 (3):496-504. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link]. [Full Text].
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. [QxMD MEDLINE Link]. [Full Text].
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. [QxMD MEDLINE Link]. [Full Text].
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. [QxMD MEDLINE Link]. [Full Text].
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. [QxMD MEDLINE Link]. [Full Text].
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. [QxMD MEDLINE Link]. [Full Text].
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. [QxMD MEDLINE Link]. [Full Text].
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. [QxMD MEDLINE Link]. [Full Text].
Mowry JB, Spyker DA, Brooks DE, McMillan N, Schauben JL. 2014 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 32nd Annual Report. Clin Toxicol (Phila). 2015. 53 (10):962-1147. [QxMD MEDLINE Link]. [Full Text].
Mowry JB, Spyker DA, Brooks DE, Zimmerman A, Schauben JL. 2015 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 33rd Annual Report. Clin Toxicol (Phila). 2016 Dec. 54 (10):924-1109. [QxMD MEDLINE Link].
Gummin DD, Mowry JB, Spyker DA, Brooks DE, Fraser MO, Banner W. 2016 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 34th Annual Report. Clin Toxicol (Phila). 2017 Dec. 55 (10):1072-1252. [QxMD MEDLINE Link].
Gummin DD, Mowry JB, Spyker DA, Brooks DE, Osterthaler KM, Banner W. 2017 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 35th Annual Report. Clin Toxicol (Phila). 2018 Dec. 56 (12):1213-1415. [QxMD MEDLINE Link]. [Full Text].
Gummin DD, Mowry JB, Beuhler MC, Spyker DA, Brooks DE, Dibert KW, et al. 2019 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 37th Annual Report. Clin Toxicol (Phila). 2020 Dec. 58 (12):1360-1541. [QxMD MEDLINE Link]. [Full Text].
Gummin DD, Mowry JB, Spyker DA, Brooks DE, Beuhler MC, Rivers LJ, et al. 2018 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 36th Annual Report. Clin Toxicol (Phila). 2019 Dec. 57 (12):1220-1413. [QxMD MEDLINE Link]. [Full Text].
Levine M, Ruha AM, Lovecchio F, et al. Hypoglycemia after accidental pediatric sulfonylurea ingestions. Pediatr Emerg Care. 2011 Sep. 27(9):846-9. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link]. [Full Text].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Ferner RE, Chaplin S. The relationship between the pharmacokinetics and pharmacodynamic effects of oral hypoglycaemic drugs. Clin Pharmacokinet. 1987 Jun. 12(6):379-401. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Goldfrank LR, Flomenbaum NE, Lewin NA, eds. Goldfrank's Toxicologic Emergencies. McGraw-Hill Professional Publishing; 1988. 671-87.
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. [QxMD MEDLINE Link].
Haymond MW. Hypoglycemia in infants and children. Endocrinol Metab Clin North Am. 1989 Mar. 18(1):211-52. [QxMD MEDLINE Link].
Johnson SF, Schade DS, Peake GT. Chlorpropamide-induced hypoglycemia: successful treatment with diazoxide. Am J Med. 1977 Nov. 63(5):799-804. [QxMD MEDLINE Link].
Little GL, Boniface KS. Are one or two dangerous? Sulfonylurea exposure in toddlers. Journal of Emergency Medicine. 2005. 28:305-10. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Rowden AK, Fasano CJ. Emergency management of oral hypoglycemic drug toxicity. Emerg Med Clin North Am. 2007 May. 25(2):347-56; abstract viii. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Spiller HA. Management of sulfonylurea ingestions. Pediatr Emerg Care. 1999 Jun. 15(3):227-30. [QxMD MEDLINE Link].
Spiller HA, Sawyer TS. Toxicology of oral antidiabetic medications. Am J Health Syst Pharm. 2006 May 15. 63(10):929-38. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Trenque T, Hoizey G, Lamiable D. Serious Hypoglycemia: Munchausen's Syndrome?. Diabetes Care. 2001. 24:792-3.

Media Gallery

Normal hypoglycemic counterregulation.

of 1

Table. Sulfonylurea exposures reported to the American Association of Poison Control Centers' National Data Collection System from 2006-2019

Table. Sulfonylurea exposures reported to the American Association of Poison Control Centers' National Data Collection System from 2006-2019

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
*Overall mortality includes adult and pediatric cases † Patient age not noted

Back to List

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.