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 complete blood cell (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

Imaging Studies

Head computed tomographic scanning without, and then with, intravenous contrast is recommended in patients with any of the following:

Altered mental status
Focal neurologic deficit
New-onset seizures

Other Tests

Electrocardiography (ECG) is recommended in patients with a suspected history of tricyclic antidepressant toxicity or in those with severe electrolyte abnormalities.

Treatment & Management

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].
Nakamura M, Nakade J, Toyama T, Okajima M, Taniguchi T. Severe intoxication caused by sodium-glucose cotransporter 2 inhibitor overdose: a case report. BMC Pharmacol Toxicol. 2020 Jan 9. 21 (1):5. [QxMD MEDLINE Link]. [Full Text].
Vaughan EM, Rueda JJ, Samson SL, Hyman DJ. Reducing the Burden of Diabetes Treatment: A Review of Low-cost Oral Hypoglycemic Medications. Curr Diabetes Rev. 2020. 16 (8):851-858. [QxMD MEDLINE Link]. [Full Text].
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].
Gummin DD, Mowry JB, Beuhler MC, Spyker DA, Bronstein AC, Rivers LJ, et al. 2020 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 38th Annual Report. Clin Toxicol (Phila). 2021 Dec. 59 (12):1282-1501. [QxMD MEDLINE Link]. [Full Text].
Gummin DD, Mowry JB, Beuhler MC, Spyker DA, Rivers LJ, Feldman R, et al. 2021 Annual Report of the National Poison Data System(©) (NPDS) from America's Poison Centers: 39th Annual Report. Clin Toxicol (Phila). 2022 Dec. 60 (12):1381-1643. [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].

Media Gallery

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.