What is the expected diagnosis for a patient with persistent hypoglycemia after administration of D50?

The scenario presents a patient experiencing persistent hypoglycemia despite the administration of D50 (50% dextrose), an immediate treatment for hypoglycemic episodes. The most plausible diagnosis in this context is sulfonylurea toxicity.

Sulfonylureas are a class of medications used primarily to treat type 2 diabetes by stimulating insulin release from the pancreas. If a patient has taken an excessive dose of a sulfonylurea or has a high sensitivity to the drug, it can lead to prolonged hypoglycemia. This occurs because the sulfonylurea continues to stimulate insulin secretion even in the presence of adequate or excess blood glucose levels, leading to ongoing hypoglycemia that does not resolve quickly after administering glucose.

In cases of sulfonylurea toxicity, the glucose provided by D50 may momentarily elevate blood sugar levels, but the underlying issue of excessive insulin production continues, resulting in a rapid fall in blood sugar again. This contrasts with other potential diagnoses, such as insulinoma, adrenal insufficiency, or alcohol hypoglycemia, where the mechanism of persistent low blood sugar can differ significantly.

For instance, insulinoma would generally present with hypoglycemia that could be resolved by administering glucose, and adrenal insufficiency