FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 315:1245-1250 November 13, 1986 Number 20 Next

	Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

Abstract

We analyzed 137 episodes of hypoglycemia (serum glucose less than or equal to 49 mg per deciliter) occurring in 94 adult patients hospitalized during a six-month period at a tertiary care hospital. Forty-five percent of the patients had diabetes mellitus, and administered insulin was implicated in 90 percent of episodes in diabetics. Hypoglycemia in diabetic patients occurred under a variety of circumstances, frequently because of decreased caloric intake related to illness or hospital routine. Insulin-induced hypoglycemia also occurred during treatment of hyperkalemia (eight patients) or during hyperglycemia related to total parenteral nutrition (six patients). Forty-six of the 94 patients had chronic renal insufficiency, and 20 of these 46 had underlying diabetes mellitus. Thus, renal insufficiency unrelated to diabetes mellitus was the second most frequent diagnosis associated with hypoglycemia. The majority of other cases of hypoglycemia were related to liver disease, infections, shock, pregnancy, neoplasia, or burns. Hypoglycemia was not the apparent cause of death in any patient, but the overall hospital mortality was 27 percent and was related to the degree of hypoglycemia and the number of risk factors for hypoglycemia. We conclude that hypoglycemia is a common problem in hospitalized patients, is common in renal insufficiency, is usually iatrogenic, and correlates with high mortality in severely ill patients.

This article has been cited by other articles:

• Maynard, G. A., Huynh, M. P., Renvall, M. (2008). Iatrogenic Inpatient Hypoglycemia: Risk Factors, Treatment, and Prevention: Analysis of Current Practice at an Academic Medical Center With Implications for Improvement Efforts. Diabetes Spectr. 21: 241-247 [Abstract] [Full Text]  
• Cook, C. B., Jameson, K. A., Hartsell, Z. C., Boyle, M. E., Leonhardi, B. J., Farquhar-Snow, M., Beer, K. A. (2008). Beliefs About Hospital Diabetes and Perceived Barriers to Glucose Management Among Inpatient Midlevel Practitioners. The Diabetes Educator 34: 75-83 [Abstract] [Full Text]  
• American Diabetes Association, (2008). Standards of Medical Care in Diabetes--2008. Diabetes Care 31: S12-S54 [Full Text]  
• Rivers, E. P., McCord, J., Otero, R., Jacobsen, G., Loomba, M. (2007). Clinical utility of B-type natriuretic peptide in early severe sepsis and septic shock.. J Intensive Care Med 22: 363-373 [Abstract]  
• Anthony, M. (2007). Treatment of Hypoglycemia in Hospitalized Adults: A Descriptive Study. The Diabetes Educator 33: 709-715 [Abstract] [Full Text]  
• American Diabetes Association, (2007). Standards of Medical Care in Diabetes--2007. Diabetes Care 30: S4-S41 [Full Text]  
• Daly, F F S, Little, M, Murray, L (2006). A risk assessment based approach to the management of acute poisoning. Emerg. Med. J. 23: 396-399 [Abstract] [Full Text]  
• American Diabetes Association, (2006). Standards of Medical Care in Diabetes-2006. Diabetes Care 29: S4-S42 [Full Text]  
• Abbate, A., Biondi-Zoccai, G. G.L. (2005). The difficult task of glycaemic control in diabetics with acute coronary syndromes: finding the way to normoglycaemia avoiding both hyper- and hypoglycaemia. Eur Heart J 26: 1245-1248 [Full Text]  
• Smith, W. D., Winterstein, A. G., Johns, T., Rosenberg, E., Sauer, B. C. (2005). Causes of hyperglycemia and hypoglycemia in adult inpatients. Am J Health Syst Pharm 62: 714-719 [Abstract] [Full Text]  
• Thompson, C. L., Dunn, K. C., Menon, M. C., Kearns, L. E., Braithwaite, S. S. (2005). Hyperglycemia in the Hospital. Diabetes Spectr. 18: 20-27 [Abstract] [Full Text]  
• American Diabetes Association, (2005). Standards of Medical Care in Diabetes. Diabetes Care 28: S4-S36 [Full Text]  
• Campbell, K. B., Braithwaite, S. S. (2004). Hospital Management of Hyperglycemia. Clin. Diabetes 22: 81-88 [Full Text]  
• Clement, S., Braithwaite, S. S., Magee, M. F., Ahmann, A., Smith, E. P., Schafer, R. G., Hirsch, I. B. (2004). Management of Diabetes and Hyperglycemia in Hospitals. Diabetes Care 27: 553-591 [Full Text]  
• Mikhail, N., Cope, D. (2003). Antihyperglycemic Therapy for Patients With Renal Failure. JAMA 290: 1026-1027 [Full Text]  
• Kagansky, N., Levy, S., Rimon, E., Cojocaru, L., Fridman, A., Ozer, Z., Knobler, H. (2003). Hypoglycemia as a Predictor of Mortality in Hospitalized Elderly Patients. Arch Intern Med 163: 1825-1829 [Abstract] [Full Text]  
• Trence, D. L., Kelly, J. L., Hirsch, I. B. (2003). The Rationale and Management of Hyperglycemia for In-Patients with Cardiovascular Disease: Time for Change. J. Clin. Endocrinol. Metab. 88: 2430-2437 [Abstract] [Full Text]  
• Woerle, H. J., Meyer, C., Popa, E. M., Cryer, P. E., Gerich, J. E. (2003). Renal Compensation for Impaired Hepatic Glucose Release During Hypoglycemia in Type 2 Diabetes: Further Evidence for Hepatorenal Reciprocity. Diabetes 52: 1386-1392 [Abstract] [Full Text]  
• Oguri, S., Motegi, K., Iwakura, Y., Endo, Y. (2002). Primary Role of Interleukin-1{alpha} and Interleukin-1{beta} in Lipopolysaccharide-Induced Hypoglycemia in Mice. CVI 9: 1307-1312 [Abstract] [Full Text]  
• Bates, D. W. (2002). Unexpected Hypoglycemia in a Critically Ill Patient. ANN INTERN MED 137: 110-116 [Abstract] [Full Text]  
• Cersosimo, E., Garlick, P., Ferretti, J. (2001). Abnormal Glucose Handling by the Kidney in Response to Hypoglycemia in Type 1 Diabetes. Diabetes 50: 2087-2093 [Abstract] [Full Text]  
• Güven, M, Bayram, F, Güven, K, Kelestimur, F (2000). Evaluation of patients admitted with hypoglycaemia to a teaching hospital in Central Anatolia. Postgrad. Med. J. 76: 150-152 [Abstract] [Full Text]  
• Ben-Ami, H., Nagachandran, P., Mendelson, A., Edoute, Y. (1999). Drug-Induced Hypoglycemic Coma in 102 Diabetic Patients. Arch Intern Med 159: 281-284 [Abstract] [Full Text]  
• Service, F.J. (1995). Hypoglycemic Disorders. NEJM 332: 1144-1152 [Full Text]  
• Mirtallo, J. M., Powell, C. R., Campbell, S. M., Schneider, P. J., Kudsk, K. A. (1987). Invited Review: Cost-Effective Nutrition Support. Nutr Clin Pract 2: 142-151  
• Sunyecz, L. A., Cicci, A. J., Mirtallo, J. M. (1973). Nutrition Support of the Diabetic Patient. Clin-Alert 11: 290-299 [Abstract]  
• Meyer, C., Stumvoll, M., Dostou, J., Welle, S., Haymond, M., Gerich, J. (2002). Renal substrate exchange and gluconeogenesis in normal postabsorptive humans. Am. J. Physiol. Endocrinol. Metab. 282: E428-E434 [Abstract] [Full Text]