Inadvertent Sulfonylurea Overdose and treatment with Octreotide: A Case Report

Abstract

The most common complication of sulfonylurea overdose is hypoglycemia [1]. The toxicity is caused secondary to the exertion of the sulfonylurea pharmacological properties. It reduces the glucose level by release of insulin from beta cells of the pancreas [2]. Early symptoms of hypoglycemia from sulfonylureas are characterized by weakness, hunger, diaphoresis, pallor, palpitations, sinus tachycardia, headache, irritability, and tremor. If hypoglycemia remains untreated, neuroglycopenia may develop resulting in impaired concentration and judgment, confusion, blurred vision, drowsiness, and amnesia. Further progression can result in seizures or coma, and possibly death [3]. Conventional therapy of hypoglycemia with intravenous dextrose infusions may only temporarily correct blood sugar levels as sulfonylurea and active metabolite levels may remain high for a prolonged period of time resulting in persistent hypoglycemia [4]. Although octreotide use has been advocated as a first line therapy, indications and dosing are not firmly established. It has also been identified that the use of octreotide may reduce the incidence of recurrent hypoglycemia that is seen with dextrose-alone therapy. Our case report discusses a patient with severe hypoglycemia resulting from suicide attempt by ingesting 24 mg of glimepiride and highlights the response to treatment with octreotide after failed attempts to correct the patient’s hypoglycemia with dextrose.