Six Years of Thiazolidinedione Exposures Reported to the TESS Database

• Published in: Clinical toxicology (Philadelphia, Pa.) Vol. 45; no. 4; p. 368
• Main Authors: Aleguas, A, Spiller, HA
• Format: Journal Article
• Language: English
• Published: 01.05.2007
• ISSN: 1556-3650

Objective: To better elucidate the toxidromes associated with thiazolidinedione (TZD) ingestion and assess the incidence of severe clinical effects. Method: A review of all thiazolidinedione ingestions reported to the TESS database for the years 2000 through 2005. Included were TZD combination products, as well as the TZD removed from the market early in 2000. Results: 8,807 patients were reported of which 6,551 were acute exposures, 1,943 were acute on chronic and 230 were chronic exposures. The three main reasons were unintentional (n = 3,920), therapeutic error (n = 31,630) and suspected suicidal (n = 1,180). 4,318 (49%) patients were managed at home. Of those patients referred to or already in a HCF, 2002 (45%) were treated and released. 3,954 patients (45%) were determined to have no effect, 690 (7%) had a minor effect, 819 (9%) had a moderate effect, and 139 (2%) had a major effect. There were 11 deaths; 5 were acute, 5 were acute on chronic and 1 was a chronic. Hypoglycemia occurred in 505 (6%) of the patients. Transaminase elevations of >1000IU was seen in 1 patient, and >100, but <1000IU in 6 patients. All of these patients were chronic or acute on chronic exposures. Of the 8,807 patients, 3,417 (39%) were less than or equal to 6 yrs., 1,458 (43%) were managed at home, and 1,036 (30%) were referred to a HCF. Of those referred or already in an HCF 1,203 (50%) were treated and released, 385 (16%) were admitted to a non-critical unit, and 158 (7%) were admitted to an ICU. 2,256 patients (66%) were determined to have no effect, 122 (4%) had a minor effect, 108 (3%) had a moderate effect, and 8 (<1%) had a major effect. There was 1 pediatric death. Hypoglycemia occurred in 98 (3%) of all pediatric exposures, and no alterations in tran-saminases were observed. Conclusion: Hypoglycemia was a rare occurrence in TZD overdoses/exposures, and elevations in transaminases are not seen with acute exposures only. The incidence of transaminase elevation or death in acute on chronic was also rare, occurring in 3, and 5 of 1,943 patients respectively. The high incidence of HCF referrals in pediatric patients less than 6 years old we believe is due to the lack of good data on the incidence of adverse effects for this class of drugs, and the understandable practice of cautious management.