0071643192.pdf

TOXICOLOGY

■ Long-acting synthetic analog of somatostatin, which inhibits the release

of insulin from the pancreas

■ Decreases dextrose requirements and further episodes of hypoglycemia

■ Antidote=diazoxide.

■ Antihypertensive/vasodilator, which also inhibits the release of insulin

from the pancreas

■ Neither as effective nor as safe as octreotide

■ Reserved for patients who don’t respond to octreotide

COMPLICATIONS

■ Disulfiram reactions (headache, flushing, N/V) are possible with all sul-

fonylureas following exposure to alcohol.

Other Antihyperglycemic Agents

Table 6.17 lists other diabetic agents that may present with acute toxicity in

overdose.

A 25-year-old male presents to the ED via EMS after being found difficult

to arouse. He has a history of cocaine binges. Physical examination

reveals sinus bradycardia, dry skin, and normal temperature. The patient

is alert and oriented after vigorous stimulation. Urine toxicology screen is posi-

tive for cocaine metabolites. What is the treatment?

Despite the positive drug screen, this is not cocaine toxicity and there is no

immediate treatment necessary. The screen doesn’t correlate with toxicity, and

this is more likely a “wash out” period following a cocaine binge. The manage-

ment includes observation and ruling out other serious pathology.

Nonspecific symptoms in

patient on metformin? Suspect

lactic acidosis.

TABLE 6.17. Toxicity From Other Hypoglycemic Agents

ANTIHYPERGLYCEMICCLASS MECHANISM OFACTION SYMPTOMS/EXAM

Biguanides (metformin) ↑Peripheral glucose use Lactic acidosis →N/V, malaise,

↓Hepatic production and tachypnea

intestinal absorption Does NOT cause hypoglycemia

of glucose

Glinide derivatives Release of insulin Hypoglycemia (similar to

sulfonylureas)

α-Glucosidase Delays breakdown of No reported toxicity in acute

inhibitors complex carbohydrates overdose

in small intestines

Thiazoladinediones ↑Insulin sensitivity No reported toxicity in acute

overdose