Causes, management and morbidity of acute hypoglycaemia in adults requiring hospital admission

Abstract

In the community, acute hypoglycaemia is commonly caused by therapies for diabetes mellitus or the excessive consumption of alcohol. Although most episodes do not require admission to hospital, little information is available on the causes and outcome of those that do. We retrospectively surveyed adult patients admitted to a large urban teaching hospital with acute hypoglycaemia in a 12-month period, identifying 56 admissions of 51 patients. Forty-one had diabetes mellitus, 33 (80%) of whom were receiving treatment with insulin. The others had hypoglycaemia induced by excessive consumption of alcohol or by deliberate self-poisoning with insulin. A history of psychiatric illness and/or chronic alcoholism was common. Neurological manifestations of hypoglycaemia were the principal reason for admission, observed on 50 occasions (89%), and 11 events (20%) had precipitated convulsions. Although many patients (59%) had received treatment for hypoglycaemia before admission, hypoglycaemia recurred in 16% of patients in hospital. Four patients (7%) died following admission, but in only one case was this the direct result of hypoglycaemia. However, within 15 months of the index hypoglycaemia event, a further six patients (11%) had died, mostly of causes unrelated to hypoglycaemia. Patients who require hospital admission for treatment of hypoglycaemia have a high incidence of neurological manifestations, a high rate of mental illness and other medical disorders, and may represent a high-risk subgroup with a poor long-term prognosis.

Insulinoma Presenting with Psychiatric Manifestations: A Case Report

“…It is most common in those with diabetes receiving insulin or oral hypoglycaemics, but also occurs in patients with liver disease, renal insufficiency, congestive heart failure, sepsis, malnutrition, or cancer 9 . Factitious or surreptitious use of insulin or sulfonylurea drugs is probably the most common cause of hypoglycaemia among patients who do not have diabetes 10 .…”

Glucose Homeostasis – Mechanism and Defects

“…Hospitalization is required in a minority of patients, usually for observation of neurologic signs during hypoglycemia, such as seizures, obtundation, coma, or focal neurologic signs. The need for hospitalization arises most commonly in diabetic patients, although hypoglycemia is frequently identified in patients with malnutrition and associated alcohol consumption, mental illness, or severe underlying medical illness [Hart & Frier, 1998]. Hypoglycemia occurs in 1.2% of hospitalized patients and is of somewhat more diverse etiology [Fischer et al, 1986].…”

Addictive Disorders in Nutritional Diseases ‐ From a Nutritional Viewpoint

“…found that 14% of admissions of DKAwere cocaine users. Hart and Frier [15] found 19% of diabetics were admitted with severe hypoglycemia due to alcohol intake.…”