Sulfonylurea Poisoning
Description Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: T38.3 DESCRIPTION Sulfonylureas may cause severe and protracted hypoglycaemia. The half-life of the sulfonylureas varies: Glibenclamide: T 1/2 = 10 hours Gliclazide: T 1/2 = 10-12 hours Glimepiride: T 1/2 = 5-8 hours DIAGN
Description
Diagnostic criteria
General and supportive measures
Medicine treatment
Referral
ICD-10 code: T38.3
DESCRIPTION
Sulfonylureas may cause severe and protracted hypoglycaemia. The half-life of the sulfonylureas varies:
- Glibenclamide: T1/2 = 10 hours
- Gliclazide: T1/2 = 10-12 hours
- Glimepiride: T1/2 = 5-8 hours
DIAGNOSTIC CRITERIA
Clinical
- Coma and seizures.
- Profound hypoglycaemia, usually within 4 hours of ingestion.
Investigations
- Glucose monitoring is the mainstay of diagnostic testing.
GENERAL AND SUPPORTIVE MEASURES
- Observe for at least 24 hours, even if a single tablet is ingested.
- Glucose-containing fluid orally.
MEDICINE TREATMENT
- Activated charcoal; see: Poisoning, Treatment.
If symptoms of hypoglycaemia are present or blood glucose is below 2.6 mmol/L:
- Dextrose 10% (2 mL/kg), IV bolus followed by 10% dextrose maintenance infusion. Titrate until blood glucose is controlled.
If desired response not achieved,
ADD
- Octreotide 1 – 1.5 µg/kg IV or SC.
Note:
Corticosteroids are not indicated.
REFERRAL
- Patients not responding to intravenous glucose.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Paediatrics, 2023 Edition
Chapter 18: Poisoning, 18.1 Poisoning, 18.1.15 Sulfonylurea Poisoning