Intoxicaciones por antidiabéticos orales en España. Análisis y evolución a lo largo de 13 años (1991-2003) / Poisonings by oral antidiabetics drugs in Spain. Analysis and evolution during 13 years (1991-2003)

Introducción. La prevalencia de diabetes tipo 2aumenta y aumentará en los próximos años. El tratamiento farmacológico de la diabetes tipo 2 inicialmente son los antidiabéticos orales. El objetivo de nuestro estudio es conocer la existencia y evolución de las intoxicaciones por antidiabéticos orales en España, durante el período 1991-2003.Resultados. El número total de intoxicacionesfue de 309 sujetos, siendo más frecuentes en mujeres (52,9%) que en hombres (47,1%). Las intoxicaciones fueron clasificadas en asintomáticas el 13,9%, leves el 49,5%, moderadas el 31,3% y graves el 5,1%. El grupo farmacológico conmayor número de intoxicaciones fue el de lassulfonilureas 66,5%, y dentro de éste el grupo delas glibenclamidas. En los últimos años sepresentan intoxicaciones con más de un fármaco,presentándose en el año 2002 una intoxicación portriple terapia (sulfonilurea-biguanida y inhibidor dela alfa glucosidasa). Es importante destacar laausencia de mortalidad y la evolución de lasintoxicaciones, con un aumento del número decasos de metformina y disminución de losinhibidores de alfa-glucosidasa. En nuestro estudio,destacamos el mayor número de intoxicaciones enel grupo de lactantes y niños respecto a los adultos.Todo pone de manifiesto la importancia de uncentro de referencia para estudios epidemiológicos,la correcta prescripción y el riesgo cada vez mayordel colectivo de niños al aumentar la población dediabéticos, y con ella la prescripción de losantidiabéticos orales

Introduction. The prevalence of diabetes type 2increases and increased in the next years.The pharmacology treatment of the diabetestype 2 is the oral antidiabetic oral drugs. Theobjective of our study is to know the existence andevolution of the poisonings by oral antidiabeticsin Spain. We have studied the poisonings registeredby oral antidiabetics in the National System ofinformation toxicological, centre of nationalreference for acute poisonings in our country,during period 1991-2003.Results. The total number of poisonings was of309 subjects, being more frequent in women 52.9%versus 47.1% in men. The clinical poisonings wereclassified in asymptomatic 13.9%, low symptoms49.5% moderate serious 31.3% serious 5.1%. Thepharmacologic group with greater number ofpoisonings was of sulfonilurea 66.5%, within thisgroup the glyburide one. In the last years poisoningswith but of a drug appear appearing in the 2002poisoning by triple therapy (sulfonilurea-metforminand alpha-glucosidase inhibitor). It is important toemphasize the absence of mortality and themodification of prescription increase of casesof metformin and diminution of alpha-glucosidaseinhibitor. In our study we emphasized the greaterone I number of poisonings in group of sucklingbabies and children with respect to the adults.Everything shows the importance of the correctprescription and use of the oral antidiabetics

Antidiabetic medications in overdose: a comparison of the inquiries made to a regional poisons unit regarding original sulfonylureas, biguanides and insulin.

OBJECTIVE: The drugs most commonly used to treat diabetes mellitus are sulfonylureas, biguanides and insulin. The most serious effects seen in overdose with these agents are hypoglycemia or lactic acidosis which may be fatal or cause cerebral defects. The present investigation analyzes inquiries made to a regional poisons unit involving overdoses with sulfonylureas, biguanides and insulin. PATIENTS AND METHODS: A total of 218,070 made inquiries between 1995 and 2004 were evaluated. The inquiries were received by telephone and a standardized questionnaire was sent subsequently to the physicians calling for follow-up information. The cases were analyzed with regard to gender, age, etiology, symptoms and clinical outcome. RESULTS: 263 inquiries concerning sulfonylureas (48.3% female, 49.4% male, 2.3% sex unknown, average age 39.1 +/- 26.8 years), 172 concerning biguanides (60.5% female, 37.2% male, 2.3% sex unknown, average age 41.5 +/- 24.1 years), and 191 concerning insulin (53.9% female, 41.9% male, 4.2% sex unknown, average age 44.6 +/- 16.7) were made. In cases involving sulfonylureas, the etiology was deliberate self-poisoning in 62.7% and accidental in 31.9% (biguanides 60.5% and 29.1%, insulin 85.3% and 9.4%). Using the Poisoning Severity Score, no symptoms were observed in 41.4% of the patients with sulfonylurea overdose (biguanides 40.1%, insulin 22.5%), minor symptoms in 37.6% (biguanides 32.6%, insulin 33.5%), major symptoms in 14.4% (biguanides 13.4%, insulin 26.2%) and serious symptoms in 4.6% (biguanides 12.2%, insulin 14.7%). Returned questionnaires reporting clinical outcomes showed that a full recovery occurred in most patients (sulfonylureas 97.4%, biguanides 93.0%, insulin 94.4%), cerebral defects persisted in 1.8% of the cases involving sulfonylureas (biguanides 1.5%, insulin 2.4%), and that 0.9% of the patients with sulfonylurea overdose died (biguanides 6.1%, insulin 3.6%). CONCLUSIONS: Sulfonylureas were the most frequently observed medication in cases of overdose with antidiabetic agents. Insulin overdose caused the highest number of major and serious symptoms. Overdose with biguanides led to the most deaths.

Buformin concentrations in a case of fatal lactic acidosis.

A fatal case of lactic acidosis in a 84 year old diabetic woman taking buformin is reported. Buformin concentrations in serum, other body fluids and tissues were measured by gas chromatography. Serum buformin concentration at admission was 5.5 mg/l. Postmortem concentrations were: in serum 3.2 mg/l; in lung 2.8 mg/kg wet weight; in heart 3.0 mg/kg; in pericardial fluid 3.5 mg/l; in liver 5.2 mg/kg; in bile 6.3 mg/l; and in kidney 98 mg/kg.

[Lactic acidosis induced by excessive ingestion of metformin]. / Acidose lactique induite par l'ingestion excessive de metformine

The authors report on a case of lethal lactate acidosis during acute metformine and barbiturate poisoning. The study of energetic substrates and glucoregulation hormones demonstrated a blockade of hepatic gluconeogenesis.