Antidiabetic medicine poisoning
Insulin and sulfonylurea overdose (delayed and recurrent hypoglycaemia, octreotide, observation periods), metformin-associated lactic acidosis and the EXTRIP dialysis criteria, and overdose of SGLT2 inhibitors, GLP-1 receptor agonists and other newer agents.
Tier 1Condition
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Insulin and sulfonylureas cause the dangerous poisonings, through prolonged and recurrent hypoglycaemia.
- Metformin doesn't cause hypoglycaemia at usual overdose doses. Large ingestions cause lactic acidosis that can kill and needs early dialysis.
- Newer agents (DPP-4 inhibitors, SGLT2 inhibitors, GLP-1 receptor agonists, pioglitazone, acarbose) rarely cause serious toxicity alone.
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Sources
- Therapeutic Guidelines: Toxicology and Toxinology (December 2024 update)AU/NZTherapeutic Guidelines Limited, 2024
- Poisons Information Centre (13 11 26)AU/NZNSW Poisons Information Centre, Sydney Children's Hospitals Network
- Calello DP, Liu KD, Wiegand TJ et al. Extracorporeal treatment for metformin poisoning: systematic review and recommendations from the Extracorporeal Treatments in Poisoning Workgroup. Crit Care Med 2015;43:1716-30Critical Care Medicine, 2015
- Fasano CJ, O'Malley G, Dominici P et al. Comparison of octreotide and standard therapy versus standard therapy alone for the treatment of sulfonylurea-induced hypoglycemia. Ann Emerg Med 2008;51:400-6Annals of Emergency Medicine, 2008
- Klein-Schwartz W, Stassinos GL, Isbister GK. Treatment of sulfonylurea and insulin overdose. Br J Clin Pharmacol 2016;81:496-504British Journal of Clinical Pharmacology, 2016
- Hoegberg LCG, Gosselin S, Buckley NA et al. Recommendations from the Clinical Toxicology Recommendations Collaborative on the administration of activated charcoal in acute oral overdose. Clin Toxicol 2026;64:419-75Clinical Toxicology, 2026
- Horowitz KM et al. Severe hypoglycemia and hypothermia in massive metformin overdose. Clin Toxicol 2025Clinical Toxicology, 2025
- Last updated
- 14 November 2026
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