Octreotide

Long-acting synthetic octapeptide analogue of somatostatin useful in the control of sulfonylurea-induced hypoglycaemia (BSL <4 mol/L) either from overdose or an iatrogenic source. It is also useful in hypoglycaemia induced from Quinine.

Administration

• Administer 50 micrograms IV, then…..
• Commence an infusion at 25 micrograms/hour. Dilute 500 micrograms of octreotide in 500ml of 0.9% saline and infuse at 25 ml/hour
• Alternatively give 100 micrograms SC or IM every 6 hours, although break through hypoglycaemia may occur.
• Euglycaemia is usually maintained while on the infusion but if it dose occur correct with 50% dextrose and double the infusion rate.
• Euglycaemia needs to be maintained for 12 hours off an infusion before the patient is medically cleared
• Paediatric doses = 1 microgram/kg as a bolus IV of SC and also 1 microgram/kg/hour as an infusion IV.

References

• Boyle PJ, Justice K, Krentz AJ et al.  Octreotide reverses hyperinsulinemia and prevents hypoglycemia induced by sulfonylurea overdoses. Journal of Clinical Endocrinology and Metabolism 1993; 77:752-756.
• 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. Annals of Emergency Medicine 2008; 51:400-406.
• McLaughlin SA, Crandall CS, McKinney PE.  Octreotide: an antidote for sulfonylurea-induced hypoglycemia. Annals of Emergency Medicine 2000; 36:133-138.