Causes and clinical presentations of hypoglycemia in patients with low blood glucose admitted to the emergency ward

Hypoglycemia is a medical emergency with severe side effects and also nonspecific symptoms. This survey aims at determining the causes and symptoms of hypoglycemia in patients with low blood glucose admitted to the emergency ward, approaches for prevention in hypoglycemia and decrease of further side effects are proposes. All patients with symptoms of hypoglycemia and blood glucose less than 45 mg/dl admitted to the emergency ward, between 2002 and 2003, were included in this survey. Initially a questionnaire on demographic information, coexisting disorders and drug history was completed, physical exam was done and 10 ml venous samples were obtained for CBC, liver and renal function tests. Hormonal assay and 72 hour fasting assessment was done. 89 patients with a mean age of 66.73±14.91 were included 53% females and 47% males (P= NS). 86.5% were diabetic and 13.5% nondiabetic (P< 0.001). Common causes were: drugs (36.3%), renal failure (23%), sepsis (14.3%) and medical mismanagement (11%). The most common symptoms in diabetic and nondiabetic patients were adrenergic + norglycopenic 50.6% and 58.3%, norglycopenic 46.8% and 41.7%, and adrenergic 2.6% and 0% respectively (P=NS). Drugs were the most common cause of hypoglycemia, although medical mismanagement was also observed in 11% of patients. Education not only for patients but also for medical groups is the basis of prevention. High percentage of patients had norglycopenic symptoms due to long durations of diabetes and old age as an independent risk factor, drugs should hence be used contiously in older patients also training physicians especially for geriatric groups is recommended.