Sulfonylureas are used in treatment of type 2 diabetes mellitus with risk of overdose.
Sulfonylurea compounds released in 1955 used for intentional or unintentional overdose.
New sulfonylureas introduced in 1984 are stronger and short-lasting than first-generation drug.
Sulfonylureas can cause hypoglycemia even with small doses and onset may be delayed. Excessive insulin release causes hypoglycemia from sulfonylurea toxicity.
Binding to sulfonylurea receptor stimulates closing of ATP-sensitive potassium channels on pancreatic beta cells.
The depolarization of beta cells releases insulin to reduce blood glucose levels.
Epidemiology
The American associations annual report shows a fall in oral sulfonylureas poisoning cases between 2012 and 2022.
No racial or sex predilection has been reported in sulfonylurea exposure. Toxicity can occur at all ages, but most hypoglycemic overdoses occur in 6 to 19 years old.
Approximately half pediatric exposures due to unintentional ingestion.
Anatomy
Pathophysiology
Sulfonylureas are not sulfonamides and their hypoglycemic mechanism is unknown.
It binds with potassium channels on beta-cell membrane to inhibit potassium efflux.
Sulfonylureas disrupt natural insulin regulation to give constant insulin secretion. They are metabolized in the liver, while its active metabolites are cleared with the kidneys.
Etiology
The causes of sulfonylurea toxicity are:
Drug overdose
Increased insulin sensitivity
Drug interactions
Genetic factors
Genetics
Prognostic Factors
Older patients face increased severe, recurrent hypoglycemia risks from multiple health factors.
Reduced kidney function prolongs sulfonylureas half-life. Impaired hepatic function reduces the metabolism of sulfonylureas.
Patients with malnutrition and alcohol use are at risk for hypoglycemia.
Clinical History
Collect details including medication use, dietary and lifestyle factors, and medical history to understand clinical history of patient.
Physical Examination
Neurological Examination
Cardiovascular Examination
Skin Examination
Ophthalmologic Examination
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Mild to Moderate symptoms are:
Sweating, Palpitations, Tremors, Hunger, Anxiety or nervousness
Severe symptoms are:
Seizures, Loss of consciousness, Coma
Differential Diagnoses
Pediatric Ethanol Toxicity
Hyperinsulinism
Hereditary Fructose Intolerance
Pediatric Adrenal Insufficiency
Pediatric Growth Hormone Deficiency
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
Glucose given intravenously quickly treats hypoglycemia with faster onset than oral sugar.
Safer for patients with mental status depression to avoid aspiration.
Glucagon is administered through intravenous, intramuscular, or subcutaneous route.
Discharge asymptomatic patients without hypoglycemia after 8 to 12 hours after successful treatment.
Lethargic patient may require oxygen, cardiac monitoring, and pulse oximetry.
No oral intake until normal mental status regained. Give IV glucose to patients with low blood sugar symptoms.
Administer activated charcoal as early as possible within 1 hour of ingestion.
Activated charcoal multiple doses for glipizide overdose due to enterohepatic circulation of hypoglycemic agent.
Sulfonylureas are used in treatment of type 2 diabetes mellitus with risk of overdose.
Sulfonylurea compounds released in 1955 used for intentional or unintentional overdose.
New sulfonylureas introduced in 1984 are stronger and short-lasting than first-generation drug.
Sulfonylureas can cause hypoglycemia even with small doses and onset may be delayed. Excessive insulin release causes hypoglycemia from sulfonylurea toxicity.
Binding to sulfonylurea receptor stimulates closing of ATP-sensitive potassium channels on pancreatic beta cells.
The depolarization of beta cells releases insulin to reduce blood glucose levels.
The American associations annual report shows a fall in oral sulfonylureas poisoning cases between 2012 and 2022.
No racial or sex predilection has been reported in sulfonylurea exposure. Toxicity can occur at all ages, but most hypoglycemic overdoses occur in 6 to 19 years old.
Approximately half pediatric exposures due to unintentional ingestion.
Sulfonylureas are not sulfonamides and their hypoglycemic mechanism is unknown.
It binds with potassium channels on beta-cell membrane to inhibit potassium efflux.
Sulfonylureas disrupt natural insulin regulation to give constant insulin secretion. They are metabolized in the liver, while its active metabolites are cleared with the kidneys.
The causes of sulfonylurea toxicity are:
Drug overdose
Increased insulin sensitivity
Drug interactions
Genetic factors
Older patients face increased severe, recurrent hypoglycemia risks from multiple health factors.
Reduced kidney function prolongs sulfonylureas half-life. Impaired hepatic function reduces the metabolism of sulfonylureas.
Patients with malnutrition and alcohol use are at risk for hypoglycemia.
Collect details including medication use, dietary and lifestyle factors, and medical history to understand clinical history of patient.
Neurological Examination
Cardiovascular Examination
Skin Examination
Ophthalmologic Examination
Mild to Moderate symptoms are:
Sweating, Palpitations, Tremors, Hunger, Anxiety or nervousness
Severe symptoms are:
Seizures, Loss of consciousness, Coma
Pediatric Ethanol Toxicity
Hyperinsulinism
Hereditary Fructose Intolerance
Pediatric Adrenal Insufficiency
Pediatric Growth Hormone Deficiency
Glucose given intravenously quickly treats hypoglycemia with faster onset than oral sugar.
Safer for patients with mental status depression to avoid aspiration.
Glucagon is administered through intravenous, intramuscular, or subcutaneous route.
Discharge asymptomatic patients without hypoglycemia after 8 to 12 hours after successful treatment.
Lethargic patient may require oxygen, cardiac monitoring, and pulse oximetry.
No oral intake until normal mental status regained. Give IV glucose to patients with low blood sugar symptoms.
Administer activated charcoal as early as possible within 1 hour of ingestion.
Activated charcoal multiple doses for glipizide overdose due to enterohepatic circulation of hypoglycemic agent.
Pediatrics, Cardiology
Schedule meal plans for patient to regulate carb intake and prevent risk of hypoglycemia.
Make sure the patient’s diabetes management plan is easy to follow for elderly patients.
Adjust sulfonylurea dose in renal function cases along with monitor blood glucose level daily.
Proper awareness about sulfonylurea toxicity should be provided and its related causes with management strategies.
Appointments with a pediatrician and preventing recurrence of disorder is an ongoing life-long effort.
Pediatrics, Cardiology
Dextrose:
It provides higher amounts of glucose and increased energy intake in a small volume of fluid.
Glucagon:
It increases blood glucose concentration and uses to treat hypoglycemia.
Sulfonylureas are used in treatment of type 2 diabetes mellitus with risk of overdose.
Sulfonylurea compounds released in 1955 used for intentional or unintentional overdose.
New sulfonylureas introduced in 1984 are stronger and short-lasting than first-generation drug.
Sulfonylureas can cause hypoglycemia even with small doses and onset may be delayed. Excessive insulin release causes hypoglycemia from sulfonylurea toxicity.
Binding to sulfonylurea receptor stimulates closing of ATP-sensitive potassium channels on pancreatic beta cells.
The depolarization of beta cells releases insulin to reduce blood glucose levels.
The American associations annual report shows a fall in oral sulfonylureas poisoning cases between 2012 and 2022.
No racial or sex predilection has been reported in sulfonylurea exposure. Toxicity can occur at all ages, but most hypoglycemic overdoses occur in 6 to 19 years old.
Approximately half pediatric exposures due to unintentional ingestion.
Sulfonylureas are not sulfonamides and their hypoglycemic mechanism is unknown.
It binds with potassium channels on beta-cell membrane to inhibit potassium efflux.
Sulfonylureas disrupt natural insulin regulation to give constant insulin secretion. They are metabolized in the liver, while its active metabolites are cleared with the kidneys.
The causes of sulfonylurea toxicity are:
Drug overdose
Increased insulin sensitivity
Drug interactions
Genetic factors
Older patients face increased severe, recurrent hypoglycemia risks from multiple health factors.
Reduced kidney function prolongs sulfonylureas half-life. Impaired hepatic function reduces the metabolism of sulfonylureas.
Patients with malnutrition and alcohol use are at risk for hypoglycemia.
Collect details including medication use, dietary and lifestyle factors, and medical history to understand clinical history of patient.
Neurological Examination
Cardiovascular Examination
Skin Examination
Ophthalmologic Examination
Mild to Moderate symptoms are:
Sweating, Palpitations, Tremors, Hunger, Anxiety or nervousness
Severe symptoms are:
Seizures, Loss of consciousness, Coma
Pediatric Ethanol Toxicity
Hyperinsulinism
Hereditary Fructose Intolerance
Pediatric Adrenal Insufficiency
Pediatric Growth Hormone Deficiency
Glucose given intravenously quickly treats hypoglycemia with faster onset than oral sugar.
Safer for patients with mental status depression to avoid aspiration.
Glucagon is administered through intravenous, intramuscular, or subcutaneous route.
Discharge asymptomatic patients without hypoglycemia after 8 to 12 hours after successful treatment.
Lethargic patient may require oxygen, cardiac monitoring, and pulse oximetry.
No oral intake until normal mental status regained. Give IV glucose to patients with low blood sugar symptoms.
Administer activated charcoal as early as possible within 1 hour of ingestion.
Activated charcoal multiple doses for glipizide overdose due to enterohepatic circulation of hypoglycemic agent.
Pediatrics, Cardiology
Schedule meal plans for patient to regulate carb intake and prevent risk of hypoglycemia.
Make sure the patient’s diabetes management plan is easy to follow for elderly patients.
Adjust sulfonylurea dose in renal function cases along with monitor blood glucose level daily.
Proper awareness about sulfonylurea toxicity should be provided and its related causes with management strategies.
Appointments with a pediatrician and preventing recurrence of disorder is an ongoing life-long effort.
Pediatrics, Cardiology
Dextrose:
It provides higher amounts of glucose and increased energy intake in a small volume of fluid.
Glucagon:
It increases blood glucose concentration and uses to treat hypoglycemia.
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