title: Prolonged hypoglycemia after a suicidal ingestion of repaglinide with unexpected slow plasma elimination.
abstract: BACKGROUND
  Repaglinide is a short-acting insulin secretagogue with high interindividual variability in pharmacokinetics due to genetic polymorphisms. Little is known about repaglinide overdoses, both with respect to pharmacokinetics and appropriate management. Given its short serum half-life of less than 1 h, hypoglycemic effects of repaglinide are expected to cease within a few hours post-ingestion.
  
  
  METHODS
  A 15-year-old girl ingested 10.5 mg of repaglinide in a suicide attempt. Few hours later, she developed a strong food craving, nausea, abdominal pain, and a headache. The lowest recorded serum glucose was 44 mg/dl (2.4 mmol/l) 14 h post-ingestion. Using liquid chromatography-mass spectrometry, we detected repaglinide serum levels of 5.3, 2.6, and 1.0 ng/ml at 14, 20, and 26 h post-ingestion, respectively.
  
  
  CONCLUSIONS
  This case illustrates that in the context of overdose, repaglinide can lead to prolonged hypoglycemia. We therefore recommend glucose monitoring and observation for 24 h in all patients who remain hypoglycemic or show symptoms of hypoglycemia for an unusually long period of time.
authors.affiliation: a Poison Information Center VIZ-Freiburg, Center of Pediatrics and Adolescent Medicine , University Medical Center Freiburg , Freiburg im Breisgau , Germany ;
authors.forename: Roland
authors.initials: R
authors.lastname: Elling
authors.affiliation: a Poison Information Center VIZ-Freiburg, Center of Pediatrics and Adolescent Medicine , University Medical Center Freiburg , Freiburg im Breisgau , Germany ;
authors.forename: Marco Simon
authors.initials: MS
authors.lastname: Spehl
authors.affiliation: b Institute of Forensic Medicine, Medical Center , University of Freiburg , Freiburg im Breisgau , Germany.
authors.forename: Ariane
authors.initials: A
authors.lastname: Wohlfarth
authors.affiliation: b Institute of Forensic Medicine, Medical Center , University of Freiburg , Freiburg im Breisgau , Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Auwaerter
authors.affiliation: a Poison Information Center VIZ-Freiburg, Center of Pediatrics and Adolescent Medicine , University Medical Center Freiburg , Freiburg im Breisgau , Germany ;
authors.forename: Maren
authors.initials: M
authors.lastname: Hermanns-Clausen
mesh_terms: D000293:Adolescent; D001786:Blood Glucose / Q000378:metabolism; D002219:Carbamates / Q000008:administration & dosage / Q000097:blood / Q000506:poisoning*; D002853:Chromatography, Liquid; D062787:Drug Overdose / Q000097:blood; D005260:Female; D006207:Half-Life; D006801:Humans; D007003:Hypoglycemia / Q000097:blood* / Q000209:etiology; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000506:poisoning*; D007328:Insulin / Q000097:blood; D010880:Piperidines / Q000008:administration & dosage / Q000097:blood / Q000506:poisoning*; D053719:Tandem Mass Spectrometry
chemical_list: D001786:Blood Glucose; D002219:Carbamates; D007004:Hypoglycemic Agents; D007328:Insulin; D010880:Piperidines; C072379:repaglinide
keywords: Diabetes; genetics; intoxication