Liverpool Hospital Emergency Department
- Acute sulphyonylurea overdose
- Use has been reported in massive venlafaxine overdose (sulphonylurea like effect) o Quinine induced hypoglycaemia
- In our ED 500mcg ampoules in the fridge (remove 1/10th to obtain 50mcg) o Can come in 50mcg ampoule
Dosage and Administration
- Subcutaneous 50mcg 8 hourly (2mcg/kg up to 50mcg paediatrics)
- Intravenous – 50mcg IV bolus (2mcg/ kg up to 50mcg paediatrics) followed by infusion 25mcg/hr (1mcg/kg/hr paediatrics)
- minor nausea
- Perform serial blood glucose with aiming for concentration 4-8mmol. Baseline every 4 hours.
- Perform BSL 30-60 minutely in symptomatic or hypoglycaemic patients until sugar stable for 4 hours
- Perform BSL every 2 hours in asymptomatic patients until BSL stable for 4 hours.
- Ideally avoid repeated boluses of dextrose (will cause rebound hypoglycaemia due to insulin release) unless there is inadequate response to octreotide (can consider a dextrose infusion)
- If able to eat – encourage complex carbohydrates
- Cessation: Patient must be observed for at least 12 hours post cessation of octreotide with normal diet to ensure no further hypoglycaemia