BNF for Children 2011-2012

362 6.1.5 Treatment of diabetic nephropathy and neuropathy BNFC 2011–20126 Endocrine system2.2.1) reduces diazoxide-induced sodium and waterretention and has the added benefit of potentiating theglycaemic effect of diazoxide.If diazoxide and chlorothiazide fail to suppress excessiveglucose requirements in chronic hypoglycaemiathen octreotide or nifedipine (section 2.6.2) can beadded. Octreotide suppresses secretion of growth hormone,but growth is unlikely to be affected in the longterm.DIAZOXIDECautions ischaemic heart disease; monitor bloodpressure, during prolonged use monitor white cell andplatelet count, and regularly assess growth, bone, andpsychological development; avoid the intravenousroute if possible; extravasation can cause tissuenecrosis and single doses of 300 mg have been associatedwith angina and cerebral and myocardialinfarction; interactions: Appendix 1 (diazoxide)Renal impairment increased sensitivity to hypotensiveand hyperglycaemic effect; dose reduction maybe requiredPregnancy prolonged use in second or third trimestersmay produce alopecia and impaired glucose tolerancein neonate; inhibits uterine activitySide-effects anorexia, nausea, vomiting, hyperuricaemia,sodium and water retention, hyperglycaemia,hypotension, oedema, tachycardia, arrhythmias,extrapyramidal effects; hypertrichosis on prolongedtreatmentIndication and doseChronic intractable hypoglycaemia. By mouth or by intravenous injectionNeonate initially 5 mg/kg twice daily to establishresponse, adjust dose according to response; usualmaintenance dose 1.5–3 mg/kg 2–3 times daily; upto 7 mg/kg 3 times daily may be required in somecases, higher doses unlikely to be beneficialChild 1 month–18 years initially 1.7 mg/kg 3times daily then adjusted according to response;usual maintenance dose 1.5–3 mg/kg 2–3 timesdaily; up to 5 mg/kg 3 times daily may be requiredin some cases, higher doses unlikely to be beneficialHypertensive emergencies and resistanthypertension section 2.5.1.1Eudemine c (UCB Pharma) ATablets, diazoxide 50 mg, net price 100 = £44.64Injection, see section 2.5.1Extemporaneous formulations available seeExtemporaneous Preparations, p. 6OCTREOTIDECautions avoid abrupt withdrawal of short-actingoctreotide—see Side-effects below; in insulinoma(risk of increased depth and duration of hypoglycaemia—monitorclosely when initiating treatment andchanging doses); diabetes mellitus (antidiabeticrequirements may be reduced); monitor thyroidfunction on long-term therapy; interactions: Appendix1 (octreotide)Pregnancy possible effect on fetal growth, avoidunless benefit outweighs risk; effective contraceptionrequired during treatmentBreast-feeding avoid unless essential—present inmilk in animal studiesSide-effects anorexia, nausea, vomiting, abdominalpain, bloating, flatulence, diarrhoea, constipation, andsteatorrhoea (administer between meals or at bedtimeto reduce gastro-intestinal side-effects); bradycardia,dyspnoea, headache, dizziness; postprandial glucosetolerance may be impaired, rarely persistent hyperglycaemiawith chronic administration; hypoglycaemiahas also been reported; reduced gall bladdermotility and bile flow; gallstones reported after longtermtreatment; abrupt withdrawal of subcutaneousoctreotide is associated with biliary colic and pancreatitis;rash, alopecia; pain and irritation at injectionsite—sites should be rotated; rarely pancreatitisshortly after administration; hepatitis also reportedLicensed use not licensed in childrenIndication and dosePersistent hyperinsulinaemic hypoglycaemiaunresponsive to diazoxide and glucose. By subcutaneous injectionNeonate initially 2–5 micrograms/kg every 6–8hours, adjusted according to response; up to7 micrograms/kg every 4 hours may rarely berequiredChild 1 month–18 years initially 1–2 micrograms/kgevery 4–6 hours, dose adjustedaccording to response; up to 7 micrograms/kgevery 4 hours may rarely be requiredBleeding from oesophageal or gastric varices. By continuous intravenous infusionChild 1 month–18 years 1 microgram/kg/hour,higher doses may be required initially; when noactive bleeding reduce dose over 24 hours; usualmax. 50 micrograms/hourAdministration for intravenous infusion, dilute withSodium Chloride 0.9% to a concentration of 10–50%Sandostatin c (Novartis) AInjection, octreotide (as acetate) 50 micrograms/mL,net price 1-mL amp = £2.98; 100 micrograms/mL, 1-mL amp = £5.60; 200 micrograms/mL 5-mL vial =£69.66; 500 micrograms/mL, 1-mL amp = £27.106.1.5 Treatment of diabeticnephropathy andneuropathyDiabetic nephropathyRegular review of diabetic children over 12 years of ageshould include an annual test for microalbuminuria (theearliest sign of nephropathy). If reagent strip tests(Micral-Test II c D or Microbumintest c D) are used