Mel reviews the disposition of children with hypoglycemia from sulfonylurea ingestion.
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Mel reviews the disposition of children with hypoglycemia from sulfonylurea ingestion.
Ian L. - August 12, 2022 12:08 PM
What about the administration of octreotide ?
Mel H. - August 12, 2022 1:01 PM
Yes - absolutely the dose is: Children: 1 μg/kg SC/IV q6-12h
Michael C. - August 12, 2022 1:42 PM
Mandatory admission? Second and third generation sulfonylureas have much shorter half lives.
Maybe watch overnight if they come in at night, but otherwise observation in the ED for 6 or so hours for recrudescence after octreotide sounds more reasonable.
Mel H. - August 12, 2022 5:01 PM
Above my paid grade I will ask Mike
Mel H. - August 13, 2022 12:51 PM
FROM MIKE:
I still think there is at least mandatory prolonged observation
With second generation sulfonyoureas, the longest recorded time post ingestion is about 18 hours. In that case, exogenous dextrose (d5w) was administered prophylactically. Without prophylactic administration, the longest recorded time to hypoglycemia (glucose <50) is 13 hours in a large case series of second generation sulfonylureas.
There is not much data on glimepiride (a third generation), but maybe less. Nonetheless, I would still recommend admission (at least 12 hours of observation) for all cases of sulfonylurea ingestion.
I would not recommend prophylactic octreotide, as you need to wait at least 12 h after last administration (until it wears off), to ensure there is no further hypoglycemia. I would administer octreotide along with dextrose after the first episode of hypoglycemia.
hope this helps