Oral Hypoglycemic Agent Toxicity Treatment & Management

Updated: Feb 24, 2023
  • Author: David Tran, MD; Chief Editor: Stephen L Thornton, MD  more...
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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. [24]

At minimum, patients need intravenous access. If the patient is lethargic, then oxygen, continuous cardiac monitoring, and pulse oximeter are indicated. Until the patient totally regains normal mental status, do not administer anything by mouth.

Administer intravenous glucose to all 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 involves the ingestion of only one or two tablets of sulfonylureas, and 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.

A child in whom ingestion of any first-generation sulfonylurea (eg, chlorpropamide, acetohexamide, tolbutamide, tolazamide) is suspected should be admitted to the pediatric ward for at least 24 hours of observation, regardless of initial symptoms.

A child in whom ingestion of a second-generation sulfonylurea (eg, glyburide, glipizide, glimepiride) is suspected may be discharged safely home if the patient remains asymptomatic and euglycemic for 8-12 hours. If the patient is lethargic, comatose, or has refractory seizures, admit the patient to the intensive care unit.



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 child supervision. [25]