Hypoglycaemia: Diabetes was a common cause of presentation with hypoglycaemia

Clinical bottom line (level 4)

  1. In patients presenting with hypoglycaemia, diabetes was present in 54%
  2. In patients presenting with hypoglycaemia, alcohol was implicated in 48%
  3. In patients presenting with hypoglycaemia, causation was multiple in 25% cases
Malouf and Brust: Annals of Neurology 1985; 17: 421-430
Expires March 2003

The study

Prospective cohort study with unblinded, unobjective outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: urban ER in USA

125 patients (aged ?, ?% male) hypoglycaemia (serum glucose <60mg/dL with response to i/v dextrose)

Excluded if
  • <18 years old
  • serum glucose not confirmed before treatment





    • Outcomes studied:
  • diabetes
  • excessive alcohol intake no details on how this diagnosis was made
  • sepsis unclear definition
  • terminal cancer
  • gastroenteritis
  • hypothyroidism
  • deliberate insulin overdose

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    diabetes ? 68/125 54%
    (46% to 63%)
    excessive alcohol intake ? 60/125 48%
    (39% to 57%)
    sepsis ? 15/125 12%
    (6.3% to 18%)
    terminal cancer ? 4/125 3.2%
    (0.12% to 6.3%)
    gastroenteritis ? 2/125 1.6%
    (0.0% to 3.8%)
    hypothyroidism ? 1/125 0.80%
    (0.0% to 2.4%)
    deliberate insulin overdose ? 1/125 0.80%
    (0.0% to 2.4%)

    Comments

    1. Poor definition of the diagnostic categories used

    Citation

    1. Malouf R, and Brust JCM: Hypoglycemia: causes, neurological manifestations, and outcome. Annals of Neurology 1985; 17: 421-430
    Contributor: Matthew Taylor, Bob Phillips and Clare Wotton, March 1998
    Reviewer: -

    Clinical Question.
    Patient in a patient presenting in the emergency room
    Intervention or Exposure hypoglycaemia
    Outcome aetiology