Causes and Clinical Presentation of Hypoglycemia in Patients with Low Blood Glucose Admitted to the Emergency Ward

Hypoglycemia is a medical emergency with non-specific symptoms and severe side effects. We determined causes and symptoms of hypogly-cemia in patients with low blood glucose admit-ted to the emergency ward; approaches for the prevention in hypoglycemia and side effects are also proposed. All patients with symp-toms of hypoglycemia and blood glucose levels below 45 mg/dL admitted to the emergency ward, between 2002-2003, were included in this survey. Initially a questionnaire on demographic information, coexisting disorders and drug his-tory was completed; physical exam was done and then 10 ml of venous sample were obtained for CBC, liver and renal function tests; if indicated, hormonal assay and 72 hour fasting test were done. Eighty-nine patients with mean age of 66.73 ± 14.91 years were included; 53% female and 47% male (P= NS). 86.5% were diabetic and 13.5% nondiabetic (P< 0.001). Common causes of hypoglycemia were: drugs (36.3%), renal failure (23%), sepsis (14.3%) and medical mismanage-ment (11%). The most common symptoms in diabetic and nondiabetic patients were adrener-gic + neurglycopenic 50.6% and 58.3%, neurgly-copenic 46.8% and 41.7%, and adrenergic 2.6% and 0% respectively (P=NS). Drugs were the most common cause of hypoglycemia, although medical misman-agement was observed in 11% of patients. Educa-tion not only for patients but also for medical groups is the basis of prevention. High percent-age of patients had neurglycopenic symptoms due to long duration of diabetes and also old age as an independent risk factor; drugs should hence be used cautiously in old patients, and training physicians especially for geriatric groups is also recommended.