Hypoglycemia Management in Nondiabetic Adults at the End of Life #291

Abstract

Hypoglycemia can be both an uncomfortable symptom and a life-limiting condition. In patients with altered mental status who have a fair to good functional capacity, this could significantly detract from their ability to enjoy life. There are a variety of treatment options, including corrective action and management of the side effects of the adrenergic discharge that should be considered, as long as they are consistent with the patient’s goals of care and comfort.

Management of Severe Hypoglycemia at the End of Life in Non-Diabetic Patients: A Case Study and Recommendations

“…This can be determined by administering a 1 mg intravenous glucagon stimulation test [19]. These recommendations have been summarized in fast fact format elsewhere [20].…”

Unsuccessful cardiopulmonary resuscitation in a 46-year old woman with malignant disease and severe refractory hypoglycaemia

“…Treatment is difficult; there is no general consent on the therapy in end-stage malignant diseases. Most authors describe 25 g of dextrose in 50 mL of fluid application, some add occasional glucagon shots, and corticosteroids are suggested as the last supportive measure [5]. As an alternative fuel source, even lipids were tested and encouraging but not definitive answers were given [6].…”

Refractory Hypoglycemia at the End of Life Treated with Continuous Dextrose Infusion through Ambulatory Infusion Pump

“…Treatment options include ''corrective'' strategies as well as supportive care focused on relieving the symptoms of hypoglycemia. 1 Although artificial nutrition and hydration typically have a limited role for symptom management, quality of life, or survival at the end of life, personal values and individual goals are paramount. 2 The decision to pursue continuous ambulatory infusion of dextrose solutions at the end of life should include careful consideration of the risks and feasibility of this heroic intervention if it is necessary to achieve a dying patient's goals.…”