Kumar Juvva Gowtham, Abhilash K P P, Saya Rama Prakasha, Tadipaneni Neeha, Bose J Maheedhar
Department of Emergency Medicine and Trauma, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Tamil Nadu, India.
Department of Accident and Emergency Medicine, Christian Medical College, Vellore, Tamil Nadu, India.
Indian J Endocrinol Metab. 2017 Jan-Feb;21(1):119-124. doi: 10.4103/2230-8210.195993.
Hypoglycemia is one among the leading causes for Emergency Department (ED) visits and is the most common and easily preventable endocrine emergency. This study is aimed at assessing the incidence and elucidating the underlying causes of hypoglycemia.
A retrospective, observational study which included patients registering in ED with a finger prick blood glucose ≤60 mg/dl at the time of arrival. All patients aged above 15 years with the above inclusion criteria during the period of August 2010 to July 2013 were selected. The study group was categorized based on diabetic status into diabetic and nondiabetic groups.
A total of 1196 hypoglycemic episodes encountered at the ED during the study period were included, and of which 772 with complete data were analyzed. Underlying causes for hypoglycemia in the diabetic group (535) mainly included medication related 320 (59.81%), infections 108 (20.19%), and chronic kidney disease 61 (11.40%). Common underlying causes of hypoglycemia in nondiabetic group (237, 30.69%) included infections 107 (45.15%), acute/chronic liver disease 42 (17.72%), and malignancies 22 (9.28%). Among diabetic subjects on antidiabetic medications ( = 320), distribution over 24 h duration clearly reported two peaks at 8 and 21 h. The incidence of hypoglycemia and death per 1000 ED visits were 16.41 and 0.73 in 2011, 16.19 and 0.78 in 2012, 17.20 and 1.22 in 2013 with an average of 16.51 and 0.91, respectively.
Bimodal distribution with peaks in incidences of hypoglycemic attacks at 8 and 21 h based on hourly distribution in a day can be correlated with the times just before next meal. None of the patients should leave ED without proper evaluation of the etiology of hypoglycemia and the problem should be addressed at each individual level. Increasing incidence of death over the years is alarming, and further studies are needed to conclude the root cause.
低血糖是急诊科就诊的主要原因之一，也是最常见且易于预防的内分泌急症。本研究旨在评估低血糖的发生率并阐明其潜在病因。
一项回顾性观察研究，纳入了到达急诊科时指尖血糖≤60mg/dl的患者。选取了2010年8月至2013年7月期间所有符合上述纳入标准的15岁以上患者。研究组根据糖尿病状态分为糖尿病组和非糖尿病组。
研究期间急诊科共发生1196次低血糖事件，其中772例有完整数据并进行了分析。糖尿病组（535例）低血糖的潜在病因主要包括药物相关320例（59.81%）、感染108例（20.19%）和慢性肾脏病61例（11.40%）。非糖尿病组（237例，30.69%）低血糖的常见潜在病因包括感染107例（45.15%）、急性/慢性肝病42例（17.72%）和恶性肿瘤22例（9.28%）。在服用抗糖尿病药物的糖尿病患者中（n = 320），24小时内的分布情况清楚地显示在8小时和21小时出现两个峰值。2011年每1000次急诊科就诊的低血糖发生率和死亡率分别为16.41和0.73，2012年为16.19和0.78，2013年为17.20和1.22，平均分别为16.51和0.91。
根据一天中的每小时分布情况，低血糖发作发生率在8小时和21小时出现峰值的双峰分布可能与下次进餐前的时间相关。在未对低血糖病因进行适当评估之前，不应让任何患者离开急诊科，且应在个体层面解决该问题。多年来死亡率的上升令人担忧，需要进一步研究以确定根本原因。
