Abstract
Background and AimWe 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.MethodsWe 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.ResultsAmong 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.ConclusionSignificant 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.
Highlights
Hypoglycemia in patients without diabetes has many potential causes [1,2,3,4,5,6,7,8,9,10,11,12,13], one of which is the malicious administration of insulin [14,15,16,17,18,19]
Patient Administration System (PAS) data were linked to Patient Information and Communication System (PICS) data and patients with a recorded diagnosis of diabetes in the PAS or who were identified in PICS as having received treatment with anti-diabetic medication were excluded
We included patients admitted to the intensive care unit (ICU) in the denominator, as they invariably have a period of stay outside ICU
Summary
Hypoglycemia in patients without diabetes has many potential causes [1,2,3,4,5,6,7,8,9,10,11,12,13], one of which is the malicious administration of insulin [14,15,16,17,18,19]. Perpetrators are often carers or clinical staff, and victims their patients [19]. Prominent cases in the United Kingdom have involved multiple deaths of elderly hospital patients [15], and of children [17,18]. Better knowledge of the frequency of hypoglycemia in hospital patients is required to understand these complex forensic and clinical questions. 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
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