Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA.
Clin Toxicol (Phila). 2022 Nov;60(11):1235-1239. doi: 10.1080/15563650.2022.2125875. Epub 2022 Oct 25.
Sulfonylureas are oral antidiabetic medications that act by stimulating insulin release from pancreatic beta cells. Unintentional pediatric ingestions may result in hypoglycemia. While guidelines often recommend up to a 24-hour hospital observation period for any ingestion, the Oregon Poison Center has historically managed select patients at home. This study aimed to describe outcomes of home-managed pediatric sulfonylurea exposures and characteristics of ingestions that are appropriate for home monitoring.
This is a retrospective chart review of pediatric (≤5 years) sulfonylurea ingestions in a single poison center over a 19-year period (2002-2020). We reviewed 491 individual cases for age, ingestion quantity, witnessed or unwitnessed ingestions, hypoglycemia (<60 mg/dL), disposition, and severe events (seizures or coma). We excluded cases in which missing pills were later found or another agent was identified.
Of 474 patients meeting inclusion criteria, 135 (28%) were initially managed at home. Of these, 115 (85.3%) were ingestions of ≤1 tablet, where 68 (59%) were witnessed and 47 (41%) were unwitnessed. One hundred twenty five (92.6%) of these patients were successfully monitored at home, with 10 (7%) ultimately referred to a healthcare facility (HCF). Symptoms of hypoglycemia, measured glucose on home meter <60 mg/dL, fluctuations in monitored glucose, or parental concern were indications for HCF referral. Of those referred, 5 (4%) developed uncomplicated, asymptomatic hypoglycemia. Two of these received octreotide, at the discretion of the treating physician. No patients developed seizures or coma.
We report 135 pediatric sulfonylurea ingestions managed with initial home monitoring, the majority of which were successfully monitored at home without any reported adverse events. Ten patients "failed home monitoring," as defined by referral to a healthcare facility. Of these, five developed hypoglycemia, though no patients developed symptoms or serious adverse events.
Our findings support home observation for children ≤5 years with small ingestions of second-generation sulfonylureas.
磺酰脲类药物是一种口服降糖药，通过刺激胰岛β细胞释放胰岛素而起作用。非故意的儿科摄入可能导致低血糖。虽然指南通常建议任何摄入后观察 24 小时，但俄勒冈毒物中心历史上一直在家管理选择患者。本研究旨在描述在家管理的儿科磺酰脲类药物暴露的结果，以及适合家庭监测的摄入特征。
这是对单中心 19 年（2002-2020 年）期间儿科（≤5 岁）磺酰脲类药物摄入的回顾性图表审查。我们对 491 例个别病例进行了年龄、摄入量、目击或未目击摄入、低血糖（<60mg/dL）、处置和严重事件（癫痫发作或昏迷）的回顾。我们排除了后来发现缺失药丸或鉴定出其他药物的病例。
在符合纳入标准的 474 名患者中，有 135 名（28%）最初在家接受治疗。其中，115 名（85.3%）摄入≤1 片，其中 68 名（59%）有目击，47 名（41%）无目击。其中 125 名（92.6%）患者在家监测成功，其中 10 名（7%）最终转至医疗机构（HCF）。低血糖症状、家用血糖仪测量血糖<60mg/dL、监测血糖波动或家长担忧是转至 HCF 的指征。在转诊的患者中，有 5 名（4%）发生无症状性单纯性低血糖。其中 2 名患者根据治疗医生的判断接受了奥曲肽治疗。没有患者出现癫痫发作或昏迷。
我们报告了 135 例儿科磺酰脲类药物摄入，最初在家监测，其中大多数在家监测成功，没有任何不良事件报告。10 名患者“未能在家监测”，定义为转至医疗机构。其中 5 名患者发生低血糖，但无患者出现症状或严重不良事件。
我们的发现支持对≤5 岁儿童摄入第二代磺酰脲类药物的小剂量进行家庭观察。
