945

Abstract

Introduction: Usual treatment of hypoglycemia with dextrose 50% contributes to excessive glycemic variability, a phenomenon which has been previously associated with mortality in critically ill patients. Hypothesis: Implementation of a blood glucose specific hypoglycemia treatment protocol will provide resolution of hypoglycemic episodes with reduced glucose variability. Methods: This quasi-experimental retrospective analysis was conducted at a 772-bed community teaching hospital in Detroit, Michigan. Data regarding hypoglycemia management was collected prior to protocol implementation in February 2011. In addition to specific dextrose 50% recommendations, the hypoglycemia protocol specified frequency of blood glucose monitoring following treatment and recommendations to prevent future episodes of hypoglycemia. Glucose variability, amount of dextrose administered, subsequent glucose monitoring, hypoglycemia recurrence, and mortality were compared between pre- and post-protocol groups. Results: The blood glucose coefficient of variability in the post-protocol group (n = 53) was significantly decreased compared with the pre-protocol group (n = 52), 40.9% vs. 49.3%, respectively (p = 0.048). Amount of dextrose 50% administered was significantly reduced between groups (21.2 grams pre-protocol vs. 11.5 grams post-protocol; p < 0.001). The time to first blood glucose check was 36 minutes after protocol implementation compared to 61 minutes before the protocol (p = 0.003). The incidence of recurrent hypoglycemia following dextrose administration and ICU mortality were similar between groups. Conclusions: Implementation of the described hypoglycemia protocol provided safe and effective management of hypoglycemia with reduced glycemic variability.