Continuous Octreotide Infusion for Sulfonylurea-Induced Hypoglycemia in a Toddler

Abstract Background Ingestion of a sulfonylureaby toddlers can cause profound hypoglycemiaand neurologic sequelae. Although mild cases can be managed with dextrose and boluses of octreotide, optimal management of patients with severe hypoglycemiaand cerebral injury has not been well established. Objective Our objective was to report the use of continuous infusion octreotidefor tight glucose control after accidental sulfonylureaingestion with severe neurologic dysfunction. Case Report A 17-month-old child presented to the emergency department with marked hypoglycemia, cerebral edema, and persistent seizures after ingestion of an unknown amount of glipizide. Hypoglycemiawas refractory to i.v. dextrose bolus/infusion and subcutaneous octreotide. Continuous i.v. octreotidewas utilized in conjunction with low-volume/high-concentration dextrose infusion as treatment, allowing for tight glucose and fluid management in the setting of cerebral edema. Conclusions Continuous infusion of octreotideresulted in rapid stabilization of blood glucose levels while maintaining fluid-restriction goals. Our patient demonstrated reversibility of diffuse cerebral edemain this setting with near complete recovery of neurologic function. Octreotideadministration by continuous infusion may be preferable to subcutaneous bolus administration for the treatment of severe sulfonylurea-induced hypoglycemiawith associated neurologic injury.