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Sulfonylurea ingestion in children: Is an 8-hour observation periodsufficient?

1998; Elsevier BV; Volume: 133; Issue: 4 Linguagem: Inglês

10.1016/s0022-3476(98)70080-0

1097-6833

Halina Borowski, Thomas R. Caraccio, Howard C. Mofenson,

Antibiotics Pharmacokinetics and Efficacy

To the Editor:We were prompted by the conclusions of Spiller et al1Spiller HA Villalobos D Krenzelok EP Anderson BD Gorman SE Rose SR et al.Prospective multicenter study of sulfonylurea ingestion in children.J Pediatr. 1997; 131: 141-146Abstract Full Text Full Text PDF PubMed Scopus (48) Google Scholar to analyze our data to determine whether an 8-hour observation period after sulfonylurea ingestion (SUI) is appropriate.We reviewed 34 single cases of SUI in children reported to Long Island Poison Control Center between January 1, 1994, and December 30, 1997. We identified 4 children (ages 17 months to 3 years) who were initially free of symptoms and normoglycemic and who had hypoglycemia (<60 mg/dL) more than 8 hours after ingestion. One patient had hypoglycemia 28 hours after ingestion of 100 mg of chlorpropamide while receiving intravenous glucose. There were 3 patients with glipizide ingestions of 5 to 10 mg who subsequently became hypoglycemic at 12.5, 9.5, and 8.5 hours after ingestion. Only 1 of them never received intravenous glucose.There are reports in the literature of children demonstrating late hypoglycemia after SUI.2Frederick KA, Wang RY. Delayed hypoglycemia in a child after ingestion of a single glipizide. North American Congress of Toxicology 94; Salt Lake City, Utah. Abstract 107.Google Scholar Spiller et al also described 2 hypoglycemic patients in their own study.1Spiller HA Villalobos D Krenzelok EP Anderson BD Gorman SE Rose SR et al.Prospective multicenter study of sulfonylurea ingestion in children.J Pediatr. 1997; 131: 141-146Abstract Full Text Full Text PDF PubMed Scopus (48) Google Scholar In Spiller's prior retrospective study, he identified 4 children who had hypoglycemia more than 8 hours after ingestion.3Quadrani DA Spiller HA Widder P Five year retrospective evaluation of sulfonylurea ingestion in children.Clin Toxicol. 1996; 34: 267-270Crossref Scopus (53) Google Scholar Among 313 cases reviewed, a total of 11 patients had hypoglycemia more than 8 hours after SUI (incidence rate of 3.5%).At present, we recommend caution in following Spiller's suggestion of only 8 hours of observation. More studies are needed to determine what is the shortest and safest time to monitor these children. Our limited review suggests that 12 hours might be sufficient for glipizide ingestion. However, ingestion of chlorpropamide should be considered separately in view of its long half-life, and it requires a longer observation period. To the Editor:We were prompted by the conclusions of Spiller et al1Spiller HA Villalobos D Krenzelok EP Anderson BD Gorman SE Rose SR et al.Prospective multicenter study of sulfonylurea ingestion in children.J Pediatr. 1997; 131: 141-146Abstract Full Text Full Text PDF PubMed Scopus (48) Google Scholar to analyze our data to determine whether an 8-hour observation period after sulfonylurea ingestion (SUI) is appropriate.We reviewed 34 single cases of SUI in children reported to Long Island Poison Control Center between January 1, 1994, and December 30, 1997. We identified 4 children (ages 17 months to 3 years) who were initially free of symptoms and normoglycemic and who had hypoglycemia (<60 mg/dL) more than 8 hours after ingestion. One patient had hypoglycemia 28 hours after ingestion of 100 mg of chlorpropamide while receiving intravenous glucose. There were 3 patients with glipizide ingestions of 5 to 10 mg who subsequently became hypoglycemic at 12.5, 9.5, and 8.5 hours after ingestion. Only 1 of them never received intravenous glucose.There are reports in the literature of children demonstrating late hypoglycemia after SUI.2Frederick KA, Wang RY. Delayed hypoglycemia in a child after ingestion of a single glipizide. North American Congress of Toxicology 94; Salt Lake City, Utah. Abstract 107.Google Scholar Spiller et al also described 2 hypoglycemic patients in their own study.1Spiller HA Villalobos D Krenzelok EP Anderson BD Gorman SE Rose SR et al.Prospective multicenter study of sulfonylurea ingestion in children.J Pediatr. 1997; 131: 141-146Abstract Full Text Full Text PDF PubMed Scopus (48) Google Scholar In Spiller's prior retrospective study, he identified 4 children who had hypoglycemia more than 8 hours after ingestion.3Quadrani DA Spiller HA Widder P Five year retrospective evaluation of sulfonylurea ingestion in children.Clin Toxicol. 1996; 34: 267-270Crossref Scopus (53) Google Scholar Among 313 cases reviewed, a total of 11 patients had hypoglycemia more than 8 hours after SUI (incidence rate of 3.5%).At present, we recommend caution in following Spiller's suggestion of only 8 hours of observation. More studies are needed to determine what is the shortest and safest time to monitor these children. Our limited review suggests that 12 hours might be sufficient for glipizide ingestion. However, ingestion of chlorpropamide should be considered separately in view of its long half-life, and it requires a longer observation period. We were prompted by the conclusions of Spiller et al1Spiller HA Villalobos D Krenzelok EP Anderson BD Gorman SE Rose SR et al.Prospective multicenter study of sulfonylurea ingestion in children.J Pediatr. 1997; 131: 141-146Abstract Full Text Full Text PDF PubMed Scopus (48) Google Scholar to analyze our data to determine whether an 8-hour observation period after sulfonylurea ingestion (SUI) is appropriate. We reviewed 34 single cases of SUI in children reported to Long Island Poison Control Center between January 1, 1994, and December 30, 1997. We identified 4 children (ages 17 months to 3 years) who were initially free of symptoms and normoglycemic and who had hypoglycemia (<60 mg/dL) more than 8 hours after ingestion. One patient had hypoglycemia 28 hours after ingestion of 100 mg of chlorpropamide while receiving intravenous glucose. There were 3 patients with glipizide ingestions of 5 to 10 mg who subsequently became hypoglycemic at 12.5, 9.5, and 8.5 hours after ingestion. Only 1 of them never received intravenous glucose. There are reports in the literature of children demonstrating late hypoglycemia after SUI.2Frederick KA, Wang RY. Delayed hypoglycemia in a child after ingestion of a single glipizide. North American Congress of Toxicology 94; Salt Lake City, Utah. Abstract 107.Google Scholar Spiller et al also described 2 hypoglycemic patients in their own study.1Spiller HA Villalobos D Krenzelok EP Anderson BD Gorman SE Rose SR et al.Prospective multicenter study of sulfonylurea ingestion in children.J Pediatr. 1997; 131: 141-146Abstract Full Text Full Text PDF PubMed Scopus (48) Google Scholar In Spiller's prior retrospective study, he identified 4 children who had hypoglycemia more than 8 hours after ingestion.3Quadrani DA Spiller HA Widder P Five year retrospective evaluation of sulfonylurea ingestion in children.Clin Toxicol. 1996; 34: 267-270Crossref Scopus (53) Google Scholar Among 313 cases reviewed, a total of 11 patients had hypoglycemia more than 8 hours after SUI (incidence rate of 3.5%). At present, we recommend caution in following Spiller's suggestion of only 8 hours of observation. More studies are needed to determine what is the shortest and safest time to monitor these children. Our limited review suggests that 12 hours might be sufficient for glipizide ingestion. However, ingestion of chlorpropamide should be considered separately in view of its long half-life, and it requires a longer observation period.