Octreotide Administration Methods in Sulfonylurea Poisoning: A Retrospective Chart Review.

INTRODUCTION: Octreotide is used to treat sulfonylurea induced hypoglycemia, but the effectiveness of intravenous bolus, intravenous infusion, and subcutaneous routes of octreotide administration has not been compared. METHODS: This is a multi-center, retrospective chart review of patients with suspected sulfonylurea induced hypoglycemia who received octreotide, comparing intravenous bolus, intravenous infusion, and/or subcutaneous routes of octreotide administration. The primary outcome was number of hypoglycemic events after octreotide initiation. Secondary outcomes included total octreotide dose, dextrose administered before and after first octreotide dose, and hospital length of stay. RESULTS: Of 29 included cases, the intravenous bolus group had 10 patients, intravenous infusion group had four patients, and the subcutaneous group had 15 patients. Median post-octreotide hypoglycemic events were zero, 1.5, and zero for bolus, infusion, and subcutaneous groups, respectively. Median total octreotide dose was 50 mcg [IQR: 49 - 100 mcg], 693 mcg [IQR: 402 - 939 mcg], and 100 mcg [IQR: 50 - 150 mcg] for bolus, infusion, and subcutaneous groups, respectively. The bolus (115 grams [41 - 152 grams]) and subcutaneous groups (80 grams [53 - 189 grams]) received less post-octreotide dextrose than the infusion group (256 grams [86 - 560 grams]). Median length was 40, 60, and 62 hours between the bolus, infusion, and subcutaneous groups, respectively. CONCLUSION: The infusion group had a higher incidence of hypoglycemia and received more post-octreotide dextrose than intravenous bolus or subcutaneous groups, despite a larger total octreotide dose. These findings suggest octreotide infusions may be inferior, but further studies are needed to determine the optimal octreotide administration route for sulfonylurea induced hypoglycemia.