see: [Murray - Sulfonylureas](x-devonthink-item://DA1896AC-D57C-4A67-B2C7-65B1D27BB53E?page=380), [Cameron Paeds - oral hypoglycaemics](x-devonthink-item://F856967E-1CB8-4557-A915-88FF572C7E26?page=36) see also: [[Hypoglycaemia (paeds)]], [[Metformin overdose]], [[Insulin Overdose]] > [!Key Points] > - **risk dose:** can be [[paeds tox|one pill kills]] in kids > - Antidote:: [[octreotide]] > - note: can have *delayed hypoglycaemia* up to 18 hours post ingestion > - hypoglycaemia treated with [5mL/kg 10% dextrose](x-devonthink-item://F856967E-1CB8-4557-A915-88FF572C7E26?page=36&start=1291&length=65&search=Hypoglycaemia%20should%20be%20treated%20with%20glucose%2010%25%205%20mL%2Fkg%20IV%20bolus) (rather than the 2mL/kg often used in paeds) - Sulfonylurea agents increase pancreatic insulin secretion - They are the most important cause of [[hypoglycaemia|hypoglycaemic toxicity]] and may cause prolonged and profound life-threatening hypoglycaemia after accidental paediatric ingestion or deliberate self-poisoning - ==A single tablet in a toddler can cause life-threatening hypoglycaemia== - Onset of hypoglycaemia may be **delayed up to 18 hours after ingestion** - Large overdoses **may require treatment for several days** - Admission for a minimum of 12–24 hours is indicated for blood glucose monitoring and discharge from hospital should only occur in daylight hours # Risk assessment # Toxic Mechanism - In overdose, onset of action remains unchanged but duration of action increases - Peak plasma concentrations are generally achieved within 8 hours of an acute ingestion but may be delayed in overdose - Metabolized by the liver. Some agents have active metabolites that are renally excreted - Extensively protein bound # Clinical features mostly due to symptomatic [[Hypoglycaemia (paeds)|hypoglycaemia]] - Autonomic: tachycardia, sweating, anxiety - CNS: drowsiness, ALOC, coma, [[Seizures]] # Treatment > [!treatment] Paeds > - 5 mL/kg of 10% glucose IV **bolus** > - Then commence 1-2 mL/kg/hour 10% glucose IV **infusion** > - check BSL hourly > - [[octreotide]] infusion 1mcg/kg bolus then 1mcg/kg/hour infusion for 24 hours > - adults 50mcg IV bolus then 25mcg/hour infusion # Disposition Cease octreotide infusion when: - 10% glucose ceased for at least 4 hours - no symptoms of hypoglycemia - bedside BSLs >2.5 mmol/L (paeds) > 4 hours - daylight # OSCE - [RMH 2022 practice SCBD](x-devonthink-item://89FB68FC-9BCB-44E8-B381-CAC2493A3910?page=0) #OSCE