Hazardous factors besides infection in hypoglycemia

Abstract

Hypoglycemia is one of the most common issues encountered in daily emergency practice. In addition to the treatment of hypoglycemia, certain other situations concomitant with hypoglycemia require further treatment. The aim of the present study was to compare demographic and clinical characteristics of infected [urinary tract infection (UTI), pneumonia or biliary tract infection (BTI)] vs. non-infected hypoglycemic patients to establish which hypoglycemic patients required further observation or hospitalization. This was a retrospective cross-sectional study of hypoglycemic (<60 mg/dl) hospitalized patients. The patients were divided into two groups: Those with hypoglycemia and concurrent infection (UTIs, pneumonia or BTIs; n=103) and non-infected hypoglycemic patients (n=83). Student's t-test was performed to analyze continuous data and the χ test was used to analyze categorical data. Infections included 62 UTI, 43 pneumonia and 5 BTI. Comparing between the infected and non-infected groups, no significant differences were identified between mean glucose or body temperature, concurrent diagnosis (liver cirrhosis, uremia, acute renal failure, stroke or cancer) or mortality rate. Compared with the non-infected subjects, the infected patients were significantly older and had a significantly higher female ratio, as well as increased heart rates, white blood cell count and C-reactive protein levels. The present study proposes that characteristics, including concurrent stroke, liver cirrhosis and cancer are a point of focus in the initial management of hospitalized hypoglycemic patients.

Predisposing factors for hypoglycaemia in the emergency department

“…Previous research has shown that hypoglycaemia with concurrent UTI is commonly observed in women (male:female ratio, 0.44:1.00). 8 In that same study, patients with hypoglycaemia and concurrent UTI had a 1.2-fold higher risk of mortality than those with no UTI. 8 In our study, the prevalence of concurrent UTI was 2.4-fold higher in the advanced-age group than younger group (40.2% vs. 16.7%, respectively; p < 0.02).…”

“…One study showed that among patients with hypoglycaemia, the risk of mortality was 4.4-fold higher among those with than without concurrent liver cirrhosis. 8 Another study showed that among patients with decompensated liver cirrhosis, the rate of admission to the intensive care unit was significantly higher among those with than without hypoglycaemia. 9…”

“…12 Patients with hypoglycaemia and concurrent uraemia had a 1.4-fold higher risk of mortality than those with no uraemia. 8…”

“…Among patients with hypoglycaemia in a previous study, the risk of mortality was 2.3-fold higher among patients with than without concurrent stroke. 8…”

“…Among patients with hypoglycaemia in a previous study, the risk of mortality was 1.6-fold higher in patients with than without concurrent infection. 8 Another study showed that in the clinical management of hypoglycaemia, about one-third of patients had intractable or recurrent hypoglycaemia, and infection was related to this occurrence. Infusion of dextrose-containing intravenous fluid and administration of antibiotics were mandatory in patients with hypoglycaemia and concurrent infection.…”