Glatstein Miguel, Garcia-Bournissen Facundo, Scolnik Dennis, Koren Gideon
Division of Pediatric Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Canada.
Can J Clin Pharmacol. 2010 Winter;17(1):e51-6. Epub 2010 Feb 1.
Unintentional poisoning with sulfonylurea hypoglycaemic drugs is a serious danger to infants and children, as the ingestion of relatively small amounts can be fatal. Although the administration of octreotide is considered effective in patients that remain hypoglycaemic despite glucose administration, experience in children is limited.
A retrospective chart review of the clinical features of all children following sulfonylurea ingestion presenting between April 2001 and November 2008 at the Hospital for Sick Children in Toronto.
Ten children were identified with sulfonylurea exposure; six were classified as suspected ingestion and four had confirmed signs of sulfonylurea overdoses (mean age: 8.2 years; range 1.5 - 15). All four patients with confirmed ingestion were exposed to glyburide and developed severe hypoglycaemia; two were toddlers and two teenagers. Ingestion was accidental in the case of the toddlers, and suicidal attempts in the case of the adolescents. All patients were initially treated with glucose infusions. Both toddlers also received octreotide with favourable response and no rebound hypoglyacemia. The two teenagers were treated only with prolonged glucose infusions; in both cases rebound hypoglycaemia and increased glucose requirements were observed.
Glyburide-induced hypoglycaemia was pronounced in all patients identified. Treatment with octreotide proved effective in the 2 infants treated, agreeing with the limited experience reported to date in the literature, and suggesting that octreotide should be considered the treatment of choice in children.
磺脲类降糖药物意外中毒对婴幼儿和儿童构成严重威胁，因为摄入相对少量的该类药物也可能致命。尽管对于尽管给予葡萄糖后仍持续低血糖的患者，使用奥曲肽被认为是有效的，但儿童方面的经验有限。
对2001年4月至2008年11月期间在多伦多病童医院就诊的所有摄入磺脲类药物儿童的临床特征进行回顾性病历审查。
确定有10名儿童接触过磺脲类药物；6名被归类为疑似摄入，4名有确诊的磺脲类药物过量体征（平均年龄：8.2岁；范围1.5 - 15岁）。所有4名确诊摄入的患者均接触过格列本脲并出现严重低血糖；2名是幼儿，2名是青少年。幼儿的摄入是意外，青少年则是自杀未遂。所有患者最初均接受葡萄糖输注治疗。两名幼儿还接受了奥曲肽治疗，反应良好，且未出现低血糖反弹。两名青少年仅接受了延长的葡萄糖输注治疗；在这两个病例中均观察到低血糖反弹和葡萄糖需求量增加。
在所有确诊的患者中，格列本脲引起的低血糖都很明显。奥曲肽治疗在2名接受治疗的婴儿中被证明是有效的，这与文献中迄今报道的有限经验一致，并表明奥曲肽应被视为儿童的首选治疗方法。
