title: Continuous octreotide infusion for sulfonylurea-induced hypoglycemia in a toddler.
abstract: BACKGROUND
  Ingestion of a sulfonylurea by toddlers can cause profound hypoglycemia and neurologic sequelae. Although mild cases can be managed with dextrose and boluses of octreotide, optimal management of patients with severe hypoglycemia and cerebral injury has not been well established.
  
  
  OBJECTIVE
  Our objective was to report the use of continuous infusion octreotide for tight glucose control after accidental sulfonylurea ingestion with severe neurologic dysfunction.
  
  
  METHODS
  A 17-month-old child presented to the emergency department with marked hypoglycemia, cerebral edema, and persistent seizures after ingestion of an unknown amount of glipizide. Hypoglycemia was refractory to i.v. dextrose bolus/infusion and subcutaneous octreotide. Continuous i.v. octreotide was utilized in conjunction with low-volume/high-concentration dextrose infusion as treatment, allowing for tight glucose and fluid management in the setting of cerebral edema.
  
  
  CONCLUSIONS
  Continuous infusion of octreotide resulted in rapid stabilization of blood glucose levels while maintaining fluid-restriction goals. Our patient demonstrated reversibility of diffuse cerebral edema in this setting with near complete recovery of neurologic function. Octreotide administration by continuous infusion may be preferable to subcutaneous bolus administration for the treatment of severe sulfonylurea-induced hypoglycemia with associated neurologic injury.
authors.affiliation: Department of Pediatrics.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Llamado
authors.forename: Angela
authors.initials: A
authors.lastname: Czaja
authors.forename: Nicholas
authors.initials: N
authors.lastname: Stence
authors.forename: Jesse
authors.initials: J
authors.lastname: Davidson
mesh_terms: D005913:Glipizide / Q000506:poisoning*; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced / Q000188:drug therapy*; D007223:Infant; D007262:Infusions, Intravenous; D008297:Male; D015282:Octreotide / Q000008:administration & dosage*; D013453:Sulfonylurea Compounds / Q000506:poisoning*; D016896:Treatment Outcome
chemical_list: D013453:Sulfonylurea Compounds; D015282:Octreotide; D005913:Glipizide
keywords: cerebral edema; glipizide; hypoglycemia; magnetic resonance imaging; pediatrics