Acute Hypoglycemia in Emergency Room: A Review
Hisham Mohammed Sonbul *
King Abdulaziz University Hospital-KAUH, Saudi Arabia.
Faris Ali Hakami
Prince Mohammed bin Naser Hospital, Saudi Arabia.
Ibrahim Ahmed Almathami
Imam Mohammad Ibn Saud Islamic University, Saudi Arabia.
Ahmad Yousef Basalamah
King Abdulaziz University Rabigh, Saudi Arabia.
Riyad Khalid Almasaud
Prince Sattam Bin Abdulaziz University, Saudi Arabia.
Hasan Mohssen Alabbadi
Dhurma General Hospital, Saudi Arabia.
Mohammed Ali Alrehaily
King Saud bin Abdulaziz University for Health Sciences, Saudi Arabia.
Wesam Mostafa Edrees
King Saud bin Abdulaziz University for Health Sciences, Saudi Arabia.
Hatem Mohammed AlDhalea
Qassim University, Saudi Arabia.
Siddiqa Mohamed Ali
Salmaniya Medical Complex (Bahrain), Saudi Arabia.
Mohammed Aboud Abdullah Alqahtani
Aseer Central Hospital, Saudi Arabia.
*Author to whom correspondence should be addressed.
Abstract
Hypoglycemia is frequently encountered in the emergency department (ED) and has potential for serious morbidity. The incidence and causes of iatrogenic hypoglycemia are not known. We aim to describe how often the cause of ED hypoglycemia is iatrogenic and to identify its specific causes. Adult patients with a chief complaint or ED diagnosis of hypoglycemia, or an ED glucose value of ≤70 milligrams per deciliter (mg/dL) between 2009–2014. Two independent abstractors each reviewed charts of patients with an initial glucose ≤ 50 mg/dL, or initial glucose ≥ 70 mg/dL with a subsequent glucose ≤ 50 mg/dL, to determine if the hypoglycemia was caused by iatrogenesis.
In ED patients with hypoglycemia, iatrogenic causes are relatively common. The most frequent cause was insulin administration for hyperkalemia and uncomplicated hyperglycemia. Additionally, patients at risk of hypoglycemia in the absence of insulin, including those with alcohol intoxication or poor nutritional status, should be monitored closely in the ED.
Keywords: Acute Hypoglycemia, emergency department, hyperkalemia, insulin administration, poor nutritional status