Document Detail

Octreotide for the treatment of sulfonylurea poisoning.
MedLine Citation:
PMID:  23046209     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Sulfonylureas are used extensively for treating type-2 diabetes mellitus. Sulfonylurea poisoning can produce sustained and profound hypoglycemia refractory to IV dextrose, particularly in children and the elderly.
OBJECTIVE: To review the use of octreotide, a long-acting somatostatin analog, in the treatment of sulfonylurea-induced hypoglycemia.
METHODS: A computerized search of U.S. National Academy of Medicine, Embase, PubMed and Toxline databases was undertaken using the keywords "octreotide", "sulfonylurea", "poisoning", "intoxication", "overdose" and "children". Textbooks of Clinical Toxicology and Pharmacology and the articles cited in their bibliographies were also searched. Twenty-four publications (19 articles and five conference abstracts) were identified; no publication was excluded. PHARMACOLOGY OF OCTREOTIDE: Octreotide, a synthetic peptide analog of somatostatin, binds to G protein-coupled somatostatin-2 receptors in pancreatic beta-cells, resulting in decreased calcium influx and inhibition of insulin secretion. Octreotide markedly inhibited insulin secretion and decreased the number of hypoglycemic events and supplemental dextrose requirements in animal studies. In humans octreotide markedly inhibited insulin release, increased serum glucose concentration, reduced dextrose requirement, prevented recurrent hypoglycemia and was superior to IV dextrose and diazoxide after administration of sulfonylureas. EFFICACY OF OCTREOTIDE IN PEDIATRIC SULFONYLUREA POISONING: Fourteen pediatric patients were reported; 13 ingested second-generation sulfonylureas, with time to hypoglycemia of 1.5-16 hours. IV dextrose (10-25%) was administered before and after octreotide therapy. Octreotide was given after failure to correct hypoglycemia with IV dextrose in doses of 0.51-2 μg/kg IV or SC; two also required an IV octreotide infusion. Seven patients (50%) had recurrent hypoglycemia and received IV dextrose and additional octreotide. EFFICACY OF OCTREOTIDE IN ADULT SULFONYLUREA POISONING: Fifty-three patients were reported in prospective controlled (n = 22) and retrospective (n = 9) studies, case series (n = 6) and case reports. Fifty-one ingested second-generation sulfonylureas with time to hypoglycemia of 1-13 hours. All received IV dextrose (10-50%) before and after octreotide treatment. Octreotide 40-100 μg SC or IV was administered followed by additional doses in most patients; three patients also required an IV infusion. Octreotide significantly increased serum glucose concentrations, decreased dextrose requirement and recurrent hypoglycemic events compared with IV dextrose. Recurrent hypoglycemia was recorded in 22-50% of the patients treated with octreotide. THERAPEUTIC RECOMMENDATIONS: Based on the published clinical and pharmacokinetic data of sulfonylureas and octreotide, we suggest the following dose regimens: in children, octreotide 1-1.5 μg/kg IV or SC, followed by 2-3 more doses 6 hours apart. In adults, octreotide 50 μg SC or IV, followed by three 50 μg doses every 6 hours. During this treatment IV dextrose infusion should be gradually tapered off.
ADVERSE EVENTS: Hypertension and apnea were recorded in one pediatric patient 30 minutes after IV octreotide; the relationship to octreotide is unclear. One adult patient with chronic renal failure treated with atenolol developed severe hyperkalemia.
CONCLUSIONS: Although relatively limited, the available data suggest that octreotide should be considered first-line therapy in both pediatric and adult sulfonylurea poisoning with clinical and laboratory evidence of hypoglycemia. Maintenance doses of octreotide may be required to prevent recurrent hypoglycemia.
Miguel Glatstein; Dennis Scolnik; Yedidia Bentur
Related Documents :
25170749 - Preventive effect of baicalein on methamphetamine-induced amnesia in the passive avoida...
18163159 - Epr dosimetry in chemically treated fingernails.
10894559 - A study of doses to the hands during dispensing of radiopharmaceuticals.
23184569 - Effect of spironolactone and amiloride on thiazolidinedione-induced fluid retention in ...
12862329 - Methods for estimating radiation doses received by commercial aircrew.
25450629 - Synthesis and in vivo evaluation of novel quinoline derivatives as phosphodiesterase 10...
1496799 - Further evaluation of the use of buparvaquone in the infection and treatment method of ...
6625729 - A field trial using praziquantel (biltricider) to treat schistosoma mansoni and schisto...
2788089 - Plasma tenoxicam concentrations after single and multiple oral doses.
Publication Detail:
Type:  Journal Article; Review     Date:  2012-10-10
Journal Detail:
Title:  Clinical toxicology (Philadelphia, Pa.)     Volume:  50     ISSN:  1556-9519     ISO Abbreviation:  Clin Toxicol (Phila)     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-10-18     Completed Date:  2012-12-27     Revised Date:  2013-07-15    
Medline Journal Info:
Nlm Unique ID:  101241654     Medline TA:  Clin Toxicol (Phila)     Country:  England    
Other Details:
Languages:  eng     Pagination:  795-804     Citation Subset:  AIM; IM    
Division of Pediatric Emergency Medicine, Department of Pediatrics, Dana's Children Hospital, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Hypoglycemia / drug therapy*
Octreotide / adverse effects,  pharmacology,  therapeutic use*
Sulfonylurea Compounds / poisoning*
Reg. No./Substance:
0/Sulfonylurea Compounds; 83150-76-9/Octreotide

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Previous Document:  Incorporating sweeps and ejections into Lagrangian stochastic models of spore trajectories within pl...
Next Document:  Systemic inflammation and Alzheimer's Disease.