Dilemma of diagnosing sulphonylurea overdose in children: deliberations and considerations before reaching a diagnosis

BMJ Case Rep. 2017 Aug 28:2017:bcr2017220044. doi: 10.1136/bcr-2017-220044.

Abstract

A 15-year-old non-diabetic Caucasian girl presented with sudden onset of seizures, unrecordable blood glucose readings and acute renal failure. She denied any medication ingestion and no other precipitating factors were encountered for this acute presentation. She was treated with intravenous glucose infusion and hydrocortisone injection. Investigations showed a non-ketotic hypoglycaemia with high C-peptide and insulin levels. It took several days and multiple investigations to establish the exact cause of her persistent hypoglycaemia before it was concluded to be secondary to gliclazide overdose in a suicide attempt by the young girl. She made a complete recovery in a week with no apparent lasting neurological or renal impairment.

Keywords: Drugs: Endocrine System; Endocrine System; Paediatrics (drugs And Medicines); Psychiatry (drugs And Medicines); Renal System.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Blood Glucose / analysis
  • Diagnosis, Differential
  • Drug Overdose / urine
  • Emergency Service, Hospital
  • Female
  • Gliclazide / administration & dosage
  • Gliclazide / poisoning*
  • Gliclazide / urine
  • Glucose / administration & dosage
  • Glucose / therapeutic use
  • Humans
  • Hydrocortisone / administration & dosage
  • Hydrocortisone / therapeutic use
  • Hypoglycemia / chemically induced*
  • Hypoglycemia / complications
  • Hypoglycemia / drug therapy
  • Hypoglycemic Agents / administration & dosage
  • Hypoglycemic Agents / poisoning*
  • Infusions, Intravenous
  • Insulin / blood
  • Seizures / chemically induced*
  • Seizures / complications
  • Seizures / diagnosis*
  • Suicide, Attempted / psychology
  • Treatment Outcome

Substances

  • Blood Glucose
  • Hypoglycemic Agents
  • Insulin
  • Gliclazide
  • Glucose
  • Hydrocortisone