Original ArticlesHemiparesis and Altered Mental Status in a Child After Glyburide Ingestion 1
Introduction
Accidental sulfonylurea ingestion in children is a common occurrence. For the 5 years from 1990 through 1994, there were 7193 cases of accidental exposure to sulfonylureas in children under 6 years of age reported to poison centers 1, 2, 3, 4, 5, 6. However, serious adverse outcomes have been rare. Two recent large studies describe 278 sulfonylurea ingestions in children, with the only significant findings being the laboratory changes of low blood glucose and transient central nervous system depression 7, 8. No seizures or neurologic sequelae were noted. This lack of serious outcome may have been due to early assessment and treatment. Cases of sulfonylurea-induced neurologic sequelae have universally been associated with cases of delayed recognition of the ingestion (12–48 h) and subsequent prolonged periods of hypoglycemia without treatment 9, 10, 11, 12, 13. We report a case of accidental sulfonylurea ingestion in a child with delayed recognition of the ingestion and subsequent neurologic toxicity, including prolonged mental status changes and right-sided hemiparesis.
Section snippets
Case Report
A 6-year-old female was in her usual state of health until 6 PM the evening prior to admission when she complained of a headache and was put to bed. Her mother took her temperature, and she was afebrile. On the morning of admission, the patient woke in an agitated state. She was limp, moving only her left extremities, and responses to questions were inappropriate.
The patient was transported by the emergency medical service to the local emergency department, where she was found to be lethargic,
Discussion
In our patient, the clear lateralization of the findings suggests that the areas of the brain were not affected equally. One possible explanation for these focal effects is that they are the result of a hypoglycemia-induced seizure. A similar patchy involvement of the central nervous system has been previously reported with sulfonylurea overdose 9, 10. The reason for this asymmetrical involvement is not clear. An expected response to systemic hypoglycemia would be a global involvement rather
References (18)
- et al.
1990 Annual Report of the American Association of Poison Control Centers National Data Collection System
Am J Emerg Med
(1991) - et al.
1992 Annual Report of American Association of Poison Control Center, Toxic Exposure Surveillance System
Am J Emerg Med
(1993) - et al.
1993 Annual Report of the American Association of Poison Control Centers Toxic Surveillance System
Am J Emerg Med
(1994) - et al.
1994 Annual Report of the American Association of Poison Control Centers Toxic Exposure Surveillance System
Am J Emerg Med
(1995) - et al.
1995 Annual Report of the American Association of Poison Control Centers Toxic Exposure Surveillance System
Am J Emerg Med
(1996) - et al.
Intravenous infusion of diazoxide in the treatment of chlorpropamide-induced hypoglycemia
J Pediatr
(1978) - et al.
Focal neurologic deficits associated with hypoglycemia in children with diabetes
J Pediatr
(1990) - Litovitz TL, Holm KC, Bailey Km Schmitz BF. 1991 Annual Report of the American Association of Poison Control Centers...
- et al.
Prospective multicenter study of sulfonylurea ingestion in children
J Pediatr
(1997)
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Distinguishing characteristics of exposure to biguanide and sulfonylurea anti-diabetic medications in the United States
2022, American Journal of Emergency MedicineCitation Excerpt :For example, Gunaratne et al. reported a 56 year old man with new-onset hypoglycemia, lethargy, and confusion following unintentional sulfonylurea exposure [31]. Moreover, Spiller et al. reported a lethargic 6-year-old girl with agitation and hypoglycemia after glyburide ingestion [32]. Prior studies documenting clinical manifestations of metformin and sulfonylurea poisoning have been comprised of a small numbers of patients [33,34].
Are one or two dangerous? Sulfonylurea exposure in toddlers
2005, Journal of Emergency MedicineFocal neurological deficits with delayed resolution in a seven-year-old boy with insulin-dependent diabetes [1]
2002, American Journal of Emergency MedicineCitation Excerpt :A more likely explanation is a hypoglycemic-induced seizure with subsequent Todd's paralysis, a brief postictal paralysis of a body part involved in a focal seizure. Spiller et al10 describe a case of a child who presented with hypoglycemic hemiplegia. With immediate normalization of glucose, the focal neurological deficit persisted for 48 hours before complete resolution.
Recurrent hypoglycemic hemiparesis and aphasia in an adolescent patient
2001, Pediatric NeurologyAntidiabetic agents
2017, Critical Care Toxicology: Diagnosis and Management of the Critically Poisoned PatientA case of hypoglycemic hemiparesis and literature review
2012, Upsala Journal of Medical Sciences
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Toxicology is coordinated by Kenneth Kulig,MD, of Denver, Colorado