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Difference between revisions of "Template:Sulfonylurea Toxicity"
From WikEM
| Line 23: | Line 23: | ||
*Hyperpolarization of the beta cell results in inhibition of Ca influx and prevents insulin release | *Hyperpolarization of the beta cell results in inhibition of Ca influx and prevents insulin release | ||
*50-100 mcg subcutaneous in adults with repeat dosing Q6hrs | *50-100 mcg subcutaneous in adults with repeat dosing Q6hrs | ||
| − | *2 mcg/kg (max 150mcg) subcutaneously should be used in children | + | *2 mcg/kg (max 150mcg) subcutaneously Q6hrs should be used in children |
*Continuous infusion of 50-125 mcg/hr is an alternative in adults | *Continuous infusion of 50-125 mcg/hr is an alternative in adults | ||
| + | *Administer octreotide for 24 hours, then after discontinuing, monitor for hypoglycemia for another 24 hours | ||
====Special Considerations==== | ====Special Considerations==== | ||
| − | *Caution in using [[glucagon]] drip | + | *[[Glucagon]] 5mg IM may be used as temporizing measure, e.g. while obtaining IV access |
| − | **[[Glucagon]] also has an insulin-releasing effect | + | **Dependent on glycogen stores which may be depleted in prolonged hypglycemia |
| − | **May subsequently cause initial paradoxical hypoglycemia | + | **Also short duration of action |
| + | **Caution in using [[glucagon]] drip | ||
| + | ***[[Glucagon]] also has an insulin-releasing effect | ||
| + | ***May subsequently cause initial paradoxical hypoglycemia | ||
Latest revision as of 20:31, 8 May 2017
Contents
Hypoglycemia from Sulfonylureas[1][2]
Activated charcoal[3]
- Administer activated charcoal, preferably within 1 hr of ingestion
- Multiple doses may be beneficial, especially for glipizide
Glucose Treatment
- Initial Therapy regardless of known cause
- Adults
- 50mL D50W bolus
- Start a D10 1/2NS drip (100mL/hr)
- Children
- 1mL/kg of D50W OR
- 2mL/kg D25W OR 5-10mL/kg D10W
- Neonate: 5-10 mL/kg D10W
Octreotide[4]
- Theoretical benefit to reduce risk of recurrent hypoglycemia
- Hyperpolarization of the beta cell results in inhibition of Ca influx and prevents insulin release
- 50-100 mcg subcutaneous in adults with repeat dosing Q6hrs
- 2 mcg/kg (max 150mcg) subcutaneously Q6hrs should be used in children
- Continuous infusion of 50-125 mcg/hr is an alternative in adults
- Administer octreotide for 24 hours, then after discontinuing, monitor for hypoglycemia for another 24 hours
Special Considerations
- Glucagon 5mg IM may be used as temporizing measure, e.g. while obtaining IV access
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