The Orange Juice Clue

The parents of a 16-month-old boy who presented to the ED were concerned that he was too sleepy. His initial point-of-care glucose was noted to be 42 mg/dL, and he was somnolent but arousable, and was given orange juice.   Twenty minutes later, the child’s symptoms had completely resolved. Toxicology was consulted for evaluation of a possible toxic ingestion, and a medication inventory was recommended.   Differential Diagnosis of Hypoglycemia in Children n Ethanol intoxication n Beta blocker intoxication n Salicylate toxicity n Sulfonylurea n Insulin injection n Endocrine disorder (hypopituitarism, Addison’s disease, myxedema) n Fasting n Hepatic or metabolic disease n Unripe ackee fruit   Two hours later, the patient became lethargic again, and a repeat blood glucose was 55 mg/dL. Again, he was arousable, and treated with orange juice and 5 ml/kg of 10% dextrose in water.   Further history revealed that the father is prescribed metoprolol, glipizide, lisinopril, and atorvastatin. The mother does not take any medications, and the only over-the-counter medications in the house are acetaminophen and ibuprofen.   Because of the rebound hypoglycemia after glucose administration and the lack of other findings, we were concerned that the child had ingested glipizide, a sulfonylurea.   What is a Sulfonylurea? Sulfonylureas are used for treating type 2 diabetes mellitus. They were accidently discovered in World War II when sulfonamides, which were used...
Source: The Tox Cave - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs