Little Gary L, Boniface Keith S
Department of Emergency Medicine, George Washington University Hospital, Washington, DC.
J Emerg Med. 2005 Apr;28(3):305-310. doi: 10.1016/j.jemermed.2004.09.012.
Sulfonylurea-based oral hypoglycemics are in widespread use in the adult population, increasing the potential for unintentional exposure in children. This article examines the risk of toxicity in children under 6 years of age who ingest one to two tablets of a sulfonylurea. We review the literature on sulfonylurea toxicity, including cases reported to the American Association of Poison Control Centers (AAPCC). The ingestion of one to two sulfonylurea tablets by a small child can lead to profound hypoglycemia with severe sequelae if untreated. As a result, all potential sulfonylurea ingestions by young children should be evaluated by a physician. A capillary glucose level must be rapidly determined at presentation and should then be repeated at regular intervals for up to 8 hours. A longer observation period is recommended for the extended release preparation of glipizide. Asymptomatic children who do not develop hypoglycemia within the recommended observation period may be safely discharged home. All children who exhibit clear symptoms of hypoglycemia or glucose levels < 60 mg/dL should be admitted for supplemental glucose (oral or intravenous), with careful observation of clinical condition and monitoring of serum glucose levels. In cases refractory to intravenous glucose, therapy with octreotide or diazoxide may be beneficial.
基于磺脲类的口服降糖药在成年人群中广泛使用，增加了儿童意外接触的可能性。本文探讨了摄入1至2片磺脲类药物的6岁以下儿童的中毒风险。我们回顾了有关磺脲类药物毒性的文献，包括向美国毒物控制中心协会（AAPCC）报告的病例。幼儿摄入1至2片磺脲类药物，如果不治疗，可导致严重低血糖并伴有严重后遗症。因此，幼儿所有潜在的磺脲类药物摄入情况都应由医生进行评估。就诊时必须迅速测定毛细血管血糖水平，然后应每隔一定时间重复测定，最长达8小时。对于格列吡嗪缓释制剂，建议观察期更长。在推荐的观察期内未出现低血糖的无症状儿童可安全出院。所有出现明确低血糖症状或血糖水平<60mg/dL的儿童都应住院接受补充葡萄糖（口服或静脉注射）治疗，并仔细观察临床状况和监测血糖水平。对于静脉注射葡萄糖无效的病例，使用奥曲肽或二氮嗪治疗可能有益。
