Continuous Octreotide Infusion for Sulfonylurea-Induced Hypoglycemia in a Toddler
2013
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.
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