Abstract Hypoglycemic disorders in nondiabetic patients are rare. In the setting of concomitant illicit opioid abuse, hypoglycemia is highly unusual, and an underlying cause should be systematically investigated. We report 2 unique admissions (separated by a decade in time) to the intensive care unit for critical hypoglycemia secondary unintentional sulfonylurea exposure after heroin use. A thorough history, including illicit drug use and critical blood samples at the time of hypoglycemia, was obtained. These subjects had a common exposure: insufflation of heroin mixed with an additive shortly before their admissions with critical hypoglycemia and testing positive for unknown sulfonylurea exposure. A review of the literature was performed for cases of illicit drugs adulterated with sulfonylureas. The diagnosis and management of sulfonylurea-induced hypoglycemia are discussed. One case of sulfonylurea-positive hypoglycemia associated with inhalation of heroin was previously presented as a poster presentation at the Endocrine Society. Within 3 months of this presentation, the second case was seen. These cases highlight the importance of obtaining a detailed clinical history, acquiring timely laboratory samples for toxicologic analysis, interpreting the findings, and sharing cases like these with trainees in many disciplines to curb a potentially deadly epidemic.
Weisbrot et al. (Thu,) studied this question.