Emergency Medicine Department, National University Hospital, Level 4 National University Centre of Oral Health, 9 Lower Kent Ridge Road, Singapore, 119085, Singapore.
Department of Surgery, Yong Loo Lin School of Medicine, Singapore, Singapore.
BMC Emerg Med. 2021 May 30;21(1):66. doi: 10.1186/s12873-021-00460-0.
Uncomplicated hyperglycaemia is a common presentation in the emergency department (ED). Rapid glucose control is associated with the risk of iatrogenic hypoglycaemia. We sought to determine the safety of a rapid glucose control protocol delivered in a 24-h emergency department observation unit (OU).
This is a retrospective chart review of patients admitted to the OU for hyperglycaemia where the assessing clinician deemed there was no other reason for medical admission apart from hyperglycaemia; and that the patient could be safely discharged provided their hyperglycaemia was adequately treated. The rapid glucose control protocol consists of 4-6 hourly glucose monitoring and insulin injections according to a sliding scale. We report the demographics, reduction in glucose values and the incidence of hypoglycaemia in the OU. We also determine the rate of discharge from OU and the rate of hospital admission at 30 days.
We included 101 patients. The mean age was 53.5 years (95% CI 50.4-56.6) and 64% of patients were male. The mean HbA1c value was 12.8% (95% CI 12.3-13.3). The mean admission and discharge glucose values were 27.2 (95% CI 26.3-28.1) and 13.9 (95% CI 13.2-14.6) mmols/l respectively. There was no incidence of hypoglycaemia in the OU. We successfully discharged 90.1% of the patients from the OU, of which 3 (3.3%) patients were admitted to the hospital within 30 days of discharge.
ED OU is a safe location to deliver effective management for patients presented with uncomplicated severe hyperglycaemia.
急诊科（ED）常出现单纯性高血糖症。快速血糖控制与医源性低血糖风险相关。我们旨在确定在 24 小时 ED 观察单元（OU）中实施快速血糖控制方案的安全性。
这是一项对因高血糖而入住 OU 的患者进行的回顾性图表审查，评估医生认为除高血糖外，患者无其他住院原因，且只要高血糖得到充分治疗，患者即可安全出院。快速血糖控制方案包括根据滑动比例每 4-6 小时监测血糖和注射胰岛素。我们报告 OU 中的患者人口统计学、血糖值降低情况以及低血糖症的发生率。我们还确定 OU 出院率和 30 天内住院率。
我们纳入了 101 名患者。患者的平均年龄为 53.5 岁（95%CI 50.4-56.6），64%的患者为男性。平均 HbA1c 值为 12.8%（95%CI 12.3-13.3）。入院和出院时的平均血糖值分别为 27.2（95%CI 26.3-28.1）和 13.9（95%CI 13.2-14.6）mmol/L。OU 内未发生低血糖症。我们成功地将 90.1%的患者从 OU 出院，其中 3 名（3.3%）患者在出院后 30 天内被收治住院。
ED OU 是为单纯性重度高血糖症患者提供有效治疗的安全场所。
