Five year retrospective evaluation of sulfonylurea ingestion in children.

Abstract

Oral hypoglycemic medications are frequently used for Type II diabetes and accidental ingestions by children may occur. There are no comprehensive pediatric studies documenting poison center experiences. To evaluate the toxicity of oral sulfonylurea ingestion in children and the efficacy of treatments instituted in these cases. Retrospective review of all ingestions of oral sulfonylureas reported to a single regional poison control center 1987-1991. Ninety-three cases were identified, one to 16 years old (mean of 3.5 years). Eighty cases (86%) were less than six years of age. Of the six medications used, three, chlorpropamide, glipizide and glyburide made up 88 (95%) cases. Twenty-five patients (27%) became hypoglycemic (glucose < 60 mg/dL). The mean minimum blood glucose in these patients was 46.5 mg/dL (minimum 20 mg/dL). Time of onset of hypoglycemia ranged from 0.5 to 16 h (mean 4.3 h; median 2 h). Only four patients had the onset of chemical hypoglycemia more than four hours postexposure. Persistent hypoglycemia occurred in nine children (10%) despite intravenous glucose therapy. There were no seizures. Mean time to decontamination of patients with and without hypoglycemia was 1.4 and 1.2 h respectively. Intravenous glucose of the following concentrations was administered: 5% (40), 10% (15), 20% (1), and 50% (3). Accidental ingestion of a single tablet of chlorpropamide (250 mg), glipizide (5 mg). and glyburide (2.5 mg) each produced hypoglycemia in children ages one to four years. Accidental ingestion of 5-10 mg glyburide produced a blood glucose of 57 mg/dL in an 11-year-old child. All patients recovered fully. There were no neurological sequelae noted. Children ingesting oral hypoglycemics should be admitted to a health care facility for 24 h observation. In this series a single tablet produced hypoglycemia.