Dilemma of diagnosing sulphonylurea overdose in children: deliberations and considerations before reaching a diagnosis.

A 15-year-old non-diabetic Caucasian girl presented with sudden onset of seizures, unrecordable blood glucose readings and acute renal failure. She denied any medication ingestion and no other precipitating factors were encountered for this acute presentation. She was treated with intravenous glucose infusion and hydrocortisone injection. Investigations showed a non-ketotic hypoglycaemia with high C-peptide and insulin levels. It took several days and multiple investigations to establish the exact cause of her persistent hypoglycaemia before it was concluded to be secondary to gliclazide overdose in a suicide attempt by the young girl. She made a complete recovery in a week with no apparent lasting neurological or renal impairment.

The effectiveness of various doses of octreotide for sulfonylurea-induced hypoglycemia after overdose.

This study was conducted to investigate the effectiveness of various doses of octreotide in reducing hypoglycemic attacks and the need for dextrose in patients with refractory and recurrent hypoglycemia related to sulfonylurea toxicity. This study was carried out at the Center of Experimental Research of Selcuk University Meram School of Medicine in Konya, Turkey. A total of 40 New Zealand rabbits of both sexes, weighing between 2500 and 3000 g, were used in this experiment. Rabbits were randomly divided into 4 groups, each of which consisted of 10 animals. All animals were given oral gliclazide 100 mg. For the treatment of hypoglycemic attacks in group I, only 15 mL of 50% dextrose (7.5 g) was given intravenously; in groups II, III, and IV, octreotide was given in doses of 25 ug, 50 ug, and 100 ug, respectively. Octreotide was given to groups II, III, and IV at the 8th hour (when hypoglycemic attacks were induced), along with an intravenous infusion of an additional 15 mL of 50% dextrose (7.5 g) for each hypoglycemic attack that occurred. After the toxic dose was given, the rabbits were given the amount of dextrose used before and after octreotide administration, and the numbers of hypoglycemic attacks were recorded. The values of blood glucose for all animals were read every hour on the hour from the beginning of the study, and the study ended at the 24th hour, when hypoglycemic attacks stopped. A significant difference was observed between groups I, II, and IV in numbers of hypoglycemic attacks that occurred and dextrose doses given between 9 and 24 h (P=.001). The findings of this study suggest that a single dose of octreotide 100 ug may be used to reduce the number of refractory and recurrent hypoglycemic attacks that occur because of sulfonylurea overdose; large prospective studies are needed to validate these findings.

Gliclazide-induced hepatitis, hemiplegia and dysphasia in a suicide attempt.

The drugs used to treat diabetes mellitus are diverse and include several classes. One class is sulfonylureas which primarily cause serum glucose reduction by stimulating the release of preformed insulin from the pancreatic islets. Gliclazide, a second generation sulfonylurea, is used to control glycemic levels in non-insulin-dependent diabetes mellitus. We report a 14 year-old non-diabetic girl who developed hepatitis, hemiplegia and dysphasia after ingestion of an overdose of gliclazide (20 mg/kg/day) in a suicide attempt. Our purpose is to draw attention to the severity of gliclazide-induced neurological signs. To the best of our knowledge, gliclazide-induced hemiplegia and dysphasia have not been previously reported in the literature.

Acute renal failure after massive ingestion of gliclazide in a suicide attempt.

Gliclazide, a sulfonlyurea class molecule, is used to control glycaemic levels in non-insulin-dependent diabetes mellitus. Acute and chronic toxicity studies, conducted in various animal species, have demonstrated a very low toxicity. We report a patient who developed acute renal failure due to acute tubular necrosis following a massive ingestion of gliclazide in an suicide attempt. The patient ingested 28 grams of gliclazide; the normal dose of gliclazide is 80 mg one or twice a day. At admission the patient was hypoglycaemia and in a few days became oliguric with an increase in the serum creatinine concentration, but with a normal blood urea nitrogen level. He underwent dialysis and ten days after ingestion of gliclazide, his renal function improved rapidly.