Toxicology – Antidote: Octreotide for Sulfonylurea Poisoning

Indication

Octreotide is used for sulfonylurea or meglitinide overdose, especially when recurrent or persistent hypoglycemia is occurring.

Mechanism of Action

Octreotide is a long-acting somatostatin analog that suppresses insulin release from the pancreas.

In sulfonylurea poisoning, giving dextrose raises the blood glucose but can also stimulate additional insulin secretion, causing another episode of hypoglycemia. Octreotide helps break this cycle by reducing pancreatic insulin release.

It is usually used together with dextrose to:

• Correct low blood glucose
• Reduce recurrent hypoglycemia
• Decrease the need for repeated dextrose administration

Administration

Octreotide is typically given by subcutaneous or IV dosing at repeated intervals, with the exact regimen adjusted for age, severity, and clinical response.

Treatment should be accompanied by close glucose monitoring, particularly because recurrent hypoglycemia can occur after the initial correction.

Monitoring

Important monitoring includes:

• Frequent bedside blood glucose checks
• Mental status
• Oral intake when appropriate
• Recurrence of hypoglycemia after dextrose is reduced or stopped

Key Points

• Octreotide helps prevent the cycle of repeatedly “chasing the glucose” with dextrose.
• It works by inhibiting insulin secretion, rather than simply raising blood glucose.
• Children with suspected sulfonylurea ingestion require particularly cautious observation because even small exposures can cause prolonged hypoglycemia.
• Recurrent hypoglycemia may occur for many hours, so observation is often necessary even after the glucose initially normalizes.