Hypoglycaemia:  was often precipitated by a missed meal

Clinical bottom line (level 2b)

  1. In patients presenting to an emergency department with hypoglycaemia, most were diabetics who had not eaten (52%)
  2. In patients presenting to an emergency department with hypoglycaemia, the cause was often ascribed to alcohol (22%)
Feher et al: Archives of Emergency Medicine 1989; 6: 183-188
Expires January 2003

The study

Setting: busy A&E department (47500 cases per year) in UK

0 patients (aged mean 44y (range 8-81y), ?% male) symptoms suggestive of hypoglycaemia and/or altered consciousness, hypoglycaemia (glucose < 3 mmol/l) confirmed with Gluco-stix

Independent blinded reference standard, applied in all patients from a consecutive appropriate spectrum.
Reference standard:
  • cause of each episode documented with standardised questionnaire

The evidence


differential diagnosis number of patients prevalence
(95% CI)
missed meal 45 52%
(42% to 63%)
alcohol 19 22%
(13% to 31%)
insulin excess 13 15%
(7.5% to 23%)
exercise 9 11%
(4% to 17%)
drugs 3 3.5%
(0% to 7.5%)
renal failure 1 1%
(0% to 3.5%)
unknown 16 19%
(10% to 27%)

  • the 'drugs' causing hypoglycaemia were propranolol, glibenclamide, and metoprolol

Comments

  1. Good attempt to document the causes of hypoglycaemia presenting to A+E, but there is inadequate explanation of how the authors definitively assigned etiologies for each case.
  2. Register review of cases to ensure all documented hypoglycaemia included; but unblinded review of these cases and no magnitude of these results weighing on the total given

Citation

  1. Feher MD, Grout P, Kennedy A, et al: Hypoglycaemia in an inner-city accident and emergency department: a 12-month survey.. Archives of Emergency Medicine 1989; 6: 183-188
Contributor: Matthew Taylor and Bob Phillips, November 1999
Reviewer: Eric Vogel

Clinical Question.
Patient In patients presenting to A+E
Intervention or Exposure with hypoglycaemia
Outcome what are the common precipitants