Hypoglycemia in non-diabetic in-patients: clinical or criminal?

<h4>Background and aim</h4>We wished to establish the frequency of unexpected hypoglycemia observed in non diabetic patients outside the intensive care unit and to determine if they have a plausible clinical explanation.<h4>Methods</h4>We analysed data for 2010 from three dis...

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Autores principales:	Krishnarajah Nirantharakumar, Tom Marshall, James Hodson, Parth Narendran, Jon Deeks, Jamie J Coleman, Robin E Ferner
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2012
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/f35322d4ed1b44fba5c7c87b4291dca2
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spelling	oai:doaj.org-article:f35322d4ed1b44fba5c7c87b4291dca22021-11-18T07:13:29ZHypoglycemia in non-diabetic in-patients: clinical or criminal?1932-620310.1371/journal.pone.0040384https://doaj.org/article/f35322d4ed1b44fba5c7c87b4291dca22012-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/22768352/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background and aim</h4>We wished to establish the frequency of unexpected hypoglycemia observed in non diabetic patients outside the intensive care unit and to determine if they have a plausible clinical explanation.<h4>Methods</h4>We analysed data for 2010 from three distinct sources to identify non diabetic hypoglycaemic patients: bedside and laboratory blood glucose measurements; medication records for those treatments (high-strength glucose solution and glucagon) commonly given to reverse hypoglycemia; and diagnostic codes for hypoglycemia. We excluded from the denominator admissions of patients with a diagnosis of diabetes or prescribed diabetic medication. Case notes of patients identified were reviewed. We used capture-recapture methods to establish the likely frequency of hypoglycemia in non-diabetic in-patients outside intensive care unit at different cut-off points for hypoglycemia. We also recorded co-morbidities that might have given rise to hypoglycemia.<h4>Results</h4>Among the 37,898 admissions, the triggers identified 71 hypoglycaemic episodes at a cut-off of 3.3 mmol/l. Estimated frequency at 3.3 mmol/l was 50(CI 33-93), at 3.0 mmol/l, 36(CI 24-64), at 2.7 mmol/l, 13(CI 11-19), at 2.5 mmol/l, 11(CI 9-15) and at 2.2 mmol/l, 8(CI 7-11) per 10,000 admissions. Admissions of patients aged above 65 years were approximately 50% more likely to have an episode of hypoglycemia. Most were associated with important co-morbidities.<h4>Conclusion</h4>Significant non-diabetic hypoglycemia in hospital in-patients (at or below 2.7 mmol/l) outside critical care is rare. It is sufficiently rare for occurrences to merit case-note review and diagnostic blood tests, unless an obvious explanation is found.Krishnarajah NirantharakumarTom MarshallJames HodsonParth NarendranJon DeeksJamie J ColemanRobin E FernerPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 7, Iss 7, p e40384 (2012)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Krishnarajah Nirantharakumar Tom Marshall James Hodson Parth Narendran Jon Deeks Jamie J Coleman Robin E Ferner Hypoglycemia in non-diabetic in-patients: clinical or criminal?
description	<h4>Background and aim</h4>We wished to establish the frequency of unexpected hypoglycemia observed in non diabetic patients outside the intensive care unit and to determine if they have a plausible clinical explanation.<h4>Methods</h4>We analysed data for 2010 from three distinct sources to identify non diabetic hypoglycaemic patients: bedside and laboratory blood glucose measurements; medication records for those treatments (high-strength glucose solution and glucagon) commonly given to reverse hypoglycemia; and diagnostic codes for hypoglycemia. We excluded from the denominator admissions of patients with a diagnosis of diabetes or prescribed diabetic medication. Case notes of patients identified were reviewed. We used capture-recapture methods to establish the likely frequency of hypoglycemia in non-diabetic in-patients outside intensive care unit at different cut-off points for hypoglycemia. We also recorded co-morbidities that might have given rise to hypoglycemia.<h4>Results</h4>Among the 37,898 admissions, the triggers identified 71 hypoglycaemic episodes at a cut-off of 3.3 mmol/l. Estimated frequency at 3.3 mmol/l was 50(CI 33-93), at 3.0 mmol/l, 36(CI 24-64), at 2.7 mmol/l, 13(CI 11-19), at 2.5 mmol/l, 11(CI 9-15) and at 2.2 mmol/l, 8(CI 7-11) per 10,000 admissions. Admissions of patients aged above 65 years were approximately 50% more likely to have an episode of hypoglycemia. Most were associated with important co-morbidities.<h4>Conclusion</h4>Significant non-diabetic hypoglycemia in hospital in-patients (at or below 2.7 mmol/l) outside critical care is rare. It is sufficiently rare for occurrences to merit case-note review and diagnostic blood tests, unless an obvious explanation is found.
format	article
author	Krishnarajah Nirantharakumar Tom Marshall James Hodson Parth Narendran Jon Deeks Jamie J Coleman Robin E Ferner
author_facet	Krishnarajah Nirantharakumar Tom Marshall James Hodson Parth Narendran Jon Deeks Jamie J Coleman Robin E Ferner
author_sort	Krishnarajah Nirantharakumar
title	Hypoglycemia in non-diabetic in-patients: clinical or criminal?
title_short	Hypoglycemia in non-diabetic in-patients: clinical or criminal?
title_full	Hypoglycemia in non-diabetic in-patients: clinical or criminal?
title_fullStr	Hypoglycemia in non-diabetic in-patients: clinical or criminal?
title_full_unstemmed	Hypoglycemia in non-diabetic in-patients: clinical or criminal?
title_sort	hypoglycemia in non-diabetic in-patients: clinical or criminal?
publisher	Public Library of Science (PLoS)
publishDate	2012
url	https://doaj.org/article/f35322d4ed1b44fba5c7c87b4291dca2
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Hypoglycemia in non-diabetic in-patients: clinical or criminal?

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