PROSPECTIVE MULTICENTER STUDY OF SULFONYLUREA INGESTION IN CHILDREN

Objective: Sixty-eight percent of pediatric sulfonylurea ingestions re ported to poison centers do not result in laboratory or behavioral eff ects. Consequently, if all exposed children are admitted overnight or for 24 hours for these exposures, it will result in 600 to 700 hospita l admissions per year of children who will remain free of symptoms. We prospectively Studied exposures reported to 10 regional poison center s to determine if it were possible to differentiate those patients who would have symptoms from those who would remain symptom free. Methods : We analyzed all sulfonylurea exposures in children less than or equa l to 12 years old reported to the participating poison centers. Hypogl ycemia was defined as blood glucose (BG) concentration <60 mg/dl. Resu lts: Hypoglycemia developed in 56 (30%) of 185 exposed patients. Fifty -four of the 56 (96%) hypoglycemic patients had development of hypogly cemia within 8 hours of ingestion. Eighty-seven of the patients were i nitially managed with oral supplementation only; in 13 cases, treatmen t advanced to intravenous administration of glucose or glucagon with t he onset of hypoglycemia. There was no statistical difference in medic al outcome between patients monitored during oral supplementation vers us during intravenous infusion of dextrose. Ingestions analyzed by tim e of day did not predict risk of hypoglycemia. Sufficient data were av ailable for 103 (58%) of the 177 patients who ingested glyburide or gl ipizide to calculate a toxic dose/weight ratio. Of these 103 patients, 31 of 36 patients who ingested less than or equal to 0.3 mg/kg remain ed symptom free, whereas 31 of 67 who ingested more than 0.3 mg/kg had BG concentrations <60 mg/dl (p < 0.005, 95% confidence interval 0.05 to 0.58; sensitivity 86%, specificity 46%). Conclusion: A lack of onse t of hypoglycemia (BG >60 mg/dl) in the first 8 hours after ingestion is predictive of a benign outcome in accidental pediatric sulfonylurea ingestion. Clinical observation of children for onset of hypoglycemia during oral feeding alone appears safe. Some children with symptoms o f hypoglycemia need to receive intravenous dextrose therapy. Time of d y of ingestion is not predictive of risk of hypoglycemia. Finally, at this time it appears inappropriate to use a milligram per kilogram bod y weight dose as a guide for management decisions.