{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T19:26:12Z","timestamp":1773948372576,"version":"3.50.1"},"reference-count":16,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2008,11,18]],"date-time":"2008-11-18T00:00:00Z","timestamp":1226966400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabetic Medicine"],"published-print":{"date-parts":[[2009,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p><jats:bold>Aims\u2003<\/jats:bold> Recently, an unlicensed aphrodisiac formulation originating from China known as \u2018Power 1 Walnut\u2019 penetrated the illicit markets of South East Asia including Singapore. Subsequent toxicological analyses revealed that each \u2018Power 1 Walnut\u2019 pill was illegally adulterated with two prescription drugs\u2014sildenafil 1\u00a0mg (a PDE5 inhibitor) and glibenclamide 93\u201398\u00a0mg (a long\u2010acting sulphonylurea). As the drug was peddled to numerous people, a local \u2018hypoglycaemia epidemic\u2019 ensued, of which a small cluster presented to our hospital with severe hypoglycaemia. The aim is to characterize the demographics, clinical and labouratory aspects and postulate mechanisms for the relatively atypical presentation.<\/jats:p><jats:p><jats:bold>Methods\u2003<\/jats:bold> A retrospective study of all the patients admitted between 13th January to 15th June 2008 with hypoglycaemia was done with acquisition of all relevant data after ethical approval from our DSRB.<\/jats:p><jats:p><jats:bold>Results\u2003<\/jats:bold> 15 patients (25\u201373 years old) presented with severe hypoglycaemia. All of them presented with neuroglycopenic symptoms (5\u2010confusion, 6\u2010drowsiness to loss of consciousness, 4\u2010seizures and 1\u2010coma) 12\u201336\u00a0h after ingestion of \u2018Power 1 Walnut\u2019. Liquid chromatography\u2010mass spectrometry (LC\/MS) confirmed the presence of glibenclamide in the urine. None experienced a full\u2010blown hypoglycaemia\u2010associated autonomic response defined as sweating, sensation of warmth, anxiety, tremor, nausea, palpitations, tachycardia, and hunger. Only 4\/16 patients had symptoms of a partial autonomic response, and 3\/16 patients had tachycardia and\/or hypertension.<\/jats:p><jats:p><jats:bold>Conclusions\u2003<\/jats:bold> The above suggests an inappropriate autonomic and catecholamine response to severe hypoglycaemia in these cases of serendipitous glibenclamide overdose. Possible reasons for the blunted autonomic responses and apparent autonomic failure are reviewed.<\/jats:p>","DOI":"10.1111\/j.1464-5491.2008.02634.x","type":"journal-article","created":{"date-parts":[[2008,11,19]],"date-time":"2008-11-19T04:47:38Z","timestamp":1227070058000},"page":"105-109","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Neuroglycopenia and adrenergic responses to hypoglycaemia: insights from a local epidemic of serendipitous massive overdose of glibenclamide"],"prefix":"10.1111","volume":"26","author":[{"given":"R.","family":"Dalan","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M. K. S.","family":"Leow","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J.","family":"George","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K. Y.","family":"Chian","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"Tan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H. W.","family":"Han","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S. P.","family":"Cheow","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2009,1,5]]},"reference":[{"issue":"2","key":"e_1_2_8_2_2","first-page":"1","article-title":"Adulterated illegal sexual enhancement products. 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