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Report by Ziauddin Hassan, Registrar in Emergency Medicine
Checked by John Wright, Consultant in Emergency Medicine
Newcastle General Hospital, Newcastle, UK
A short cut review was carried out to establish whether octreotide can prevent rebound hypoglycaemia after sulfonylurea overdose. Fourteen papers were found using the reported searches, of which two presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are summarised in table 22.. It is concluded that octreotide may be safe and effective in this situation.
In [patients with sulfonylurea overdose] does [octreotide acetate] prevent [rebound hypoglycaemia]?
A 56‐year‐old man known to have non‐insulin dependent diabetes mellitus presents to the emergency department after having taken an overdose of his own oral hypoglycaemic, glipizide. The initial blood sugar value was very low, so he was given a 50 ml bolus of 50% dextrose. The patient recovered but, despite a continuous intravenous infusion of 10% dextrose, hypoglycaemia recurred. You know that intravenous dextrose stimulates insulin release, and that sulfonylurea compounds have a long half‐life. You wonder about the use of the somatostatin analogue octreotide, which causes pronounced suppression of serum immunoreactive insulin and C‐peptide concentration, and whether it is safe.
Medline 1950 to April 2007 using Ovid interface: [exp.hypoglycemia or rebound hypoglycaemia. mp] AND [exp. Hypoglycaemic agent/ or Sulfonylurea compounds/ or sulfonylurea overdose.mp or sulfonylurea poisoning.mp] AND [exp octreotide acetate or octreotide .mp] and LIMIT to human AND English.
The Cochrane Library issue 2 2007 Exp hypoglycemia [MeSH] and exp sulfonylurea compounds [MeSH] and exp octreotide [MeSH].
No relevant papers found on Cochrane library. Fourteen papers were identified on Medline of which only two were directly relevant to the question. These are summarised in table 22.
There are very few reports and most of them are reviews, case reports and letters. Each of these studies has small numbers of patients. It is difficult to recruit a large series of patients in a single centre. A large multicentre study is needed.
Octreotide may be safe and effective in preventing rebound hypoglycaemia in sulfonlyurea overdose. Octreotide in combination with dextrose can be considered for first line therapy in the treatment of sulfonlyurea‐induced hypoglycaemia