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Objectives: Characterize hypoglycemia management and identify characteristics associated with refractory (need for additional treatment following initial management) and recurrent (adequate initial treatment followed by a subsequent BG ≤ 50 mg/dL) hypoglycemia.
Study Design: Retrospective review of adult ED patients presenting to the health care system with hypoglycemia (BG ≤ 50 mg/dL) between January 2011 and July 2015 was conducted.
Methods: Data collection focused on BG obtainment and treatment practices for the first 6 hours in the ED. Data are reported using descriptive statistics, Wilcoxon rank sum and chi-square analysis as appropriate.
Results: Two-hundred forty-four patients were included (mean age 71 ± 12 years, weight 83.3 ± 24.7 kg). Patients arriving via pre-hospital care were assessed faster in the ED [median 29 minutes (IQR 12-53)] compared to ambulatory arrival [median 43 minutes (IQR 17-95)], p = 0.0018. In the ED, initial BG was 59.9 ± 46.5 mg/dL. Only 62.2% of 176 patients with BG ≤ 50 mg/dL were treated with IV bolus dextrose/glucagon and 21 patients did not receive any treatment or food. Median time to treatment was 11 min (IQR 6-23.5) and 66 min (IQR 35.75-99) for point of care and serum testing, respectively. Repeat BG was obtained 34 minutes (IQR 8-44) after treatment. Refractory or recurrent hypoglycemia occurred in 30.3%. There were no differences in the total dextrose dose received in refractory (p = 0.46) or administration of dextrose containing IV fluids/food in recurrent (p = 0.14) hypoglycemia. Infection was the only associated characteristic, p = 0.021.
Conclusions: There is a delayed time to BG in patients arriving via pre-hospital care with known hypoglycemia. Additionally, 12% of patients did not receive treatment for hypoglycemia in the ED once identified. About one-third of patients had refractory or recurrent hypoglycemia and infection was associated with this occurrence.