A study on etiological spectrum of hypoglycemia in nondiabetic patients in a rural medical teaching institution

Abstract

INTRODUCTION: Awareness regarding etiological distribution of nondiabetic hypoglycemia is poor among physicians. No study of etiological spectrum of hypoglycemia is found in rural West Bengal. We conducted this study to identify different causes of hypoglycemia in nondiabetics in a rural area of the western part of West Bengal. METHODS: Nondiabetic patients admitted in general medical ward with clinical or laboratory features of hypoglycemia with blood sugar level RESULTS: A total of 55 patients were included in this study. The most common cause of hypoglycemia was alcoholism (27.27%). Next common cause was steroid withdrawal (18.18%), especially in rheumatic patients. The third common cause was sepsis (12.73%), followed by panhypopituitarism (10.91%). Sheehan syndrome was seen in three cases. Hypoglycemia was detected in one chronic kidney disease (CKD) patient after hemodialysis (HD) and two CKD patients without HD. Hypoglycemia developed in one case of fulminant hepatitis, two cases of decompensated cirrhosis (hepatitis B and alcoholic), and two cases of congestive cardiac failure. Hypoglycemia developed in two cases of primary adrenocortical insufficiency due to tuberculosis and histoplasmosis of bilateral adrenal glands. All patients had fasting hypoglycemia except one case of dumping syndrome due to Billroth II gastrojejunostomy surgery. Other rare causes were insulinoma, malnutrition, and malignancy. CONCLUSION: Knowledge regarding different causes of hypoglycemia will increase the alertness and suspicion of possible hypoglycemia in appropriate situations. It will also help to identify underlying disorders in cases of hypoglycemia.