Template:Sulfonylurea Toxicity - Revision history

Rossdonaldson1 at 16:09, 15 March 2019

2019-03-15T16:09:35Z

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	===Hypoglycemia from [[Sulfonylurea toxicity\|Sulfonylureas]]<ref>Rowden AK, Fasano CJ. Emergency management of oral hypoglycemic drug toxicity. Emerg Med		===[[Hypoglycemia]] from [[Sulfonylurea toxicity\|Sulfonylureas]]<ref>Rowden AK, Fasano CJ. Emergency management of oral hypoglycemic drug toxicity. Emerg Med
	Clin N Am 2007; 25:347-356</ref><ref>Howland MA. Antidotes in Depth: Octreotide. In: Flomenbaum NE, Goldfrank LR, Hoffman RS et al,		Clin N Am 2007; 25:347-356</ref><ref>Howland MA. Antidotes in Depth: Octreotide. In: Flomenbaum NE, Goldfrank LR, Hoffman RS et al,
	eds: Goldfrank’s Toxicologic Emergencies. New York NY, 2006;770-773</ref>===		eds: Goldfrank’s Toxicologic Emergencies. New York NY, 2006;770-773</ref>===

Rossdonaldson1: /* Glucose Treatment */

2019-03-15T16:09:03Z

Glucose Treatment

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	====Glucose Treatment====		====Glucose Treatment====
	*Initial ~~Therapy~~ regardless of known cause		*Initial therapy regardless of known cause

	;Adults:		;Adults:

Kxl328: /* Special Considerations */

2018-09-16T20:51:15Z

Special Considerations

← Older revision		Revision as of 20:51, 16 September 2018
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	====Special Considerations====		====Special Considerations====
	*[[Glucagon]] 5mg IM may be used as temporizing measure, e.g. while obtaining IV access		*[[Glucagon]] 5mg IM may be used as temporizing measure, e.g. while obtaining IV access
	**Dependent on glycogen stores which may be depleted in prolonged ~~hypglycemia~~		**Dependent on glycogen stores which may be depleted in prolonged hypoglycemia
	**Also short duration of action		**Also short duration of action
	**Caution in using [[glucagon]] drip		**Caution in using [[glucagon]] drip
	***[[Glucagon]] also has an insulin-releasing effect		***[[Glucagon]] also has an insulin-releasing effect
	***May subsequently cause initial paradoxical hypoglycemia		***May subsequently cause initial paradoxical hypoglycemia

Lisayee25 at 20:31, 8 May 2017

2017-05-08T20:31:36Z

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	*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

Rossdonaldson1 at 05:06, 12 July 2016

2016-07-12T05:06:42Z

← Older revision		Revision as of 05:06, 12 July 2016
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	===Hypoglycemia from Sulfonylureas<ref>Rowden AK, Fasano CJ. Emergency management of oral hypoglycemic drug toxicity. Emerg Med		===Hypoglycemia from [[Sulfonylurea toxicity\|Sulfonylureas]]<ref>Rowden AK, Fasano CJ. Emergency management of oral hypoglycemic drug toxicity. Emerg Med
	Clin N Am 2007; 25:347-356</ref><ref>Howland MA. Antidotes in Depth: Octreotide. In: Flomenbaum NE, Goldfrank LR, Hoffman RS et al,		Clin N Am 2007; 25:347-356</ref><ref>Howland MA. Antidotes in Depth: Octreotide. In: Flomenbaum NE, Goldfrank LR, Hoffman RS et al,
	eds: Goldfrank’s Toxicologic Emergencies. New York NY, 2006;770-773</ref>===		eds: Goldfrank’s Toxicologic Emergencies. New York NY, 2006;770-773</ref>===

ClaireLewis: /* OctreotideFasano CJ et al. Comparison of Octreotide and standard therapy versus standard therapy alone for the treatment of sulfonylurea-induced hypoglycemia. Ann Emerg Med 2008; 51:400-406 */

2016-07-10T23:08:48Z

OctreotideFasano CJ et al. Comparison of Octreotide and standard therapy versus standard therapy alone for the treatment of sulfonylurea-induced hypoglycemia. Ann Emerg Med 2008; 51:400-406

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	*Theoretical benefit to reduce risk of recurrent hypoglycemia		*Theoretical benefit to reduce risk of recurrent hypoglycemia
	*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
	*May be effective in:
	**[[Sulfonylurea toxicity]]
	**[[Insulinoma]] - up to 50% of pts may benefit<ref>Arnold R, Simon B, Wied M. Treatment of neuroendocrine GEP tumours with somatostatin analogues: a review. Digestion. 2000. 62 Suppl 1:84-91.</ref>
	*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 should be used in children

Rossdonaldson1 at 07:54, 9 June 2016

2016-06-09T07:54:26Z

← Older revision		Revision as of 07:54, 9 June 2016
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	eds: Goldfrank’s Toxicologic Emergencies. New York NY, 2006;770-773</ref>===		eds: Goldfrank’s Toxicologic Emergencies. New York NY, 2006;770-773</ref>===

	====Activated ~~Charchoal~~<ref>Tran D et al. Oral Hypoglycemic Agent Toxicity Treatment & Management. Jul 14, 2015. http://emedicine.medscape.com/article/1010629-treatment#showall.</ref>====		====[[Activated charcoal]]<ref>Tran D et al. Oral Hypoglycemic Agent Toxicity Treatment & Management. Jul 14, 2015. http://emedicine.medscape.com/article/1010629-treatment#showall.</ref>====
	*Administer activated charcoal, preferably within 1 hr of ingestion		*Administer activated charcoal, preferably within 1 hr of ingestion
	*Multiple doses may be beneficial, especially for glipizide		*Multiple doses may be beneficial, especially for glipizide
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	;Adults:		;Adults:
	*50mL D50W bolus		*50mL [[D50W]] bolus
	*Start a D10 1/2NS drip (100mL/hr)		*Start a D10 1/2NS drip (100mL/hr)

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	*Neonate: 5-10 mL/kg D10W		*Neonate: 5-10 mL/kg D10W

	====Octreotide<ref>Fasano CJ et al. Comparison of Octreotide and standard therapy versus standard therapy alone for the treatment of sulfonylurea-induced hypoglycemia. Ann Emerg Med 2008; 51:400-406</ref>====		====[[Octreotide]]<ref>Fasano CJ et al. Comparison of Octreotide and standard therapy versus standard therapy alone for the treatment of sulfonylurea-induced hypoglycemia. Ann Emerg Med 2008; 51:400-406</ref>====
	*Theoretical benefit to reduce risk of recurrent hypoglycemia		*Theoretical benefit to reduce risk of recurrent hypoglycemia
	*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
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	====Special Considerations====		====Special Considerations====
	*Caution in using [[glucagon]] drip		*Caution in using [[glucagon]] drip
	**Glucagon also has an insulin-releasing effect		**[[Glucagon]] also has an insulin-releasing effect
	**May subsequently cause initial paradoxical hypoglycemia		**May subsequently cause initial paradoxical hypoglycemia

Tomfadial: Typographical error

2016-06-07T00:18:47Z

Typographical error

← Older revision		Revision as of 00:18, 7 June 2016
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	====Special Considerations====		====Special Considerations====
	*Caution in using [[~~Glucagon\|~~glucagon]] drip		*Caution in using [[glucagon]] drip
	**Glucagon also has an insulin-releasing effect		**Glucagon also has an insulin-releasing effect
	**May subsequently cause initial paradoxical hypoglycemia		**May subsequently cause initial paradoxical hypoglycemia

Tomfadial: Typographical error

2016-06-07T00:18:05Z

Typographical error

← Older revision		Revision as of 00:18, 7 June 2016
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	====Special Considerations====		====Special Considerations====
	*Caution in using[[Glucagon\|glucagon]] drip		*Caution in using [[Glucagon\|glucagon]] drip
	**Glucagon also has an insulin-releasing effect		**Glucagon also has an insulin-releasing effect
	**May subsequently cause initial paradoxical hypoglycemia		**May subsequently cause initial paradoxical hypoglycemia

Kxl328 at 19:35, 20 February 2016

2016-02-20T19:35:44Z

← Older revision		Revision as of 19:35, 20 February 2016
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	====Special Considerations====		====Special Considerations====
	~~Do NOT use a~~ [[Glucagon\|glucagon]] drip ~~since glucagon~~ also has an insulin-releasing effect ~~and may~~ subsequently cause hypoglycemia		*Caution in using[[Glucagon\|glucagon]] drip
			**Glucagon also has an insulin-releasing effect
			**May subsequently cause initial paradoxical hypoglycemia