CASE STUDY: ORAL HYPOGLYCEMIC DRUGS OVERDOSE INDUCED GENERALISED TONICCLONIC SEIZURES
DOI:
https://doi.org/10.22159/ajpcr.2022.v15i9.45213Keywords:
Metformin, Glimepiride, Over-dose, Hypoglycemia, SeizuresAbstract
Metformin is an oral hypoglycemic agent of the biguanide class, and glimepiride is an oral hypoglycemic agent of the sulfonylurea class frequently used to treat Type-II diabetes mellitus. Under certain conditions, overdose or long-term use of metformin and glimepiride can cause lactic acidosis and hypoglycemia. Metformin overdose can cause severe hypoglycemia in the absence of other anti-diabetic drugs. Potential mechanisms of metformin-induced hypoglycemia include decreased hepatic glucose production, decreased glucose absorption, and low oral intake. Hypoglycemia, in turn, leads to loss of consciousness, headache, confusion, and neurological symptoms such as insomnia, delirium, and in rare conditions may lead to coma, seizures, and death. Here, this case study is of 23-years-old female patient and non-diabetic presented with alleged consumption of metformin (8 g), glimepiride (32 mg) with three-episodes of generalized tonic-clonic seizures (GTCS), fever with chills, and loss of consciousness. In general, diabetic patient’s hypoglycemia condition can be more often due to drug overdosage or dietary restrictions. However, in non-diabetic patients, hypoglycemia is considered a jeopardy situation because it may lead to several fatal effects.
Downloads
References
Calello DP, Liu KD, Wiegand TJ, Roberts DM, Lavergne V, Gosselin S, et al. Extracorporeal treatment for metformin poisoning: Systematic review and recommendations from the extracorporeal treatments in poisoning workgroup. Crit Care Med 2015;43:1716-30. doi: 10.1097/ CCM.0000000000001002, PMID 25860205
Guo PY, Storsley LJ, Finkle SN. Severe lactic acidosis treated with prolonged hemodialysis: Recovery after massive overdoses of metformin. Semin Dial 2006;19:80-3. doi: 10.1111/j.1525- 139X.2006.00123.x, PMID 16423187
Bailey CJ, Turner RC. Metformin. N Engl J Med 1996;334:574-9. doi: 10.1056/NEJM199602293340906, PMID 8569826
Bell PM, Hadden DR. Metformin. Endocrinol Metab Clin N Am 1997;26:523-37. doi: 10.1016/S0889-8529(05)70265-6
Soderstrom J, Murray L, Daly FF, Little M. Toxicology case of the month: Oral hypoglycaemic overdose. Emerg Med J. 2006;23:565-7. doi: 10.1136/Emj.2006.034868, PMID 16794105
Arieff AI, Doerner T, Zelig H, Massry SG. Mechanisms of seizures and coma in hypoglycemia. Evidence for a direct effect of insulin on electrolyte transport in brain. J Clin Invest 1974;54:654-63. doi: 10.1172/JCI107803, PMID 4853137
McLaughlin SA, Crandall CS, McKinney PE. Octreotide: An antidote for sulfonylurea-induced hypoglycemia. Ann Emerg Med 2000;36:133-8. doi: 10.1067/mem.2000.108183, PMID 10918104
Aldobeaban S, Mzahim B, Alshehri AA. Recurrent hypoglycemia secondary to metformin toxicity in the absence of co-ingestions: A case report. J Med Case Rep 2018;12:223. doi: 10.1186/s13256-018-1758-0, PMID 30119705
Krentz AJ, Boyle PJ, Justice KM, Wright AD, Schade DS. Successful treatment of severe refractory sulfonylurea-induced hypoglycemia with octreotide. Diabetes Care 1993;16:184-6. doi: 10.2337/ diacare.16.1.184, PMID 8422773
Published
How to Cite
Issue
Section
Copyright (c) 2022 Anvesh kumar Kuchipudi
![Creative Commons License](http://i.creativecommons.org/l/by/4.0/88x31.png)
This work is licensed under a Creative Commons Attribution 4.0 International License.
The publication is licensed under CC By and is open access. Copyright is with author and allowed to retain publishing rights without restrictions.