Hypoglycaemia: altered consciousness was the commonest presentation of severe hypoglycaemia

Clinical bottom line (level 4)

  1. In a patient presenting with hypoglycaemia, reduced level of consciousness was the most common symptom (52%)
  2. In a patient presenting with hypoglycaemia, hemiparesis may be the only symptom (2%)
  3. In a patient presenting with hypoglycaemia, seizures were not uncommon (7%)
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:
  • Depressed sensorium
  • Behavioural change
  • Dizziness/tremor
  • Seizures
  • Sudden hemiparesis

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    Depressed sensorium ? 65/125 52%
    (43% to 61%)
    Behavioural change ? 38/125 30%
    (22% to 38%)
    Dizziness/tremor ? 10/125 8.0%
    (3.2% to 13%)
    Seizures ? 9/125 7.2%
    (2.7% to 12%)
    Sudden hemiparesis ? 3/125 2.4%
    (0.0% to 5.1%)

    Comments

    1. Unvalidated scales of consciousness level 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