Hospital hypoglycemia: not only treatment but also prevention.
OBJECTIVE
To propose a strategy, applicable on general hospital wards, for prevention of hypoglycemia in hospitalized patients.


RESULTS
Although the mortality rate among hospitalized patients with hypoglycemia has been shown to be 22.2 to 27% in series that included patients with diabetes, some investigators have shown that hypoglycemia is not an independent predictor of mortality. Outside the critical care setting, the comparative risks of hyperglycemia and hypoglycemia and the relationship of hospital hypoglycemia to intensification of glycemic control have not been determined. The reported incidence of hospital hypoglycemia ranges from 1.2% for hospitalized adults to 20% for nonpregnant patients with diabetes admitted without a metabolic emergency. Among patients receiving antihyperglycemic therapy, the literature describes precipitating events--usually a sudden change of caloric exposure-- and predisposing conditions for hypoglycemic episodes.


CONCLUSIONS
Hospital hypoglycemia is predictable, and it is preventable by measures other than undertreatment of hyperglycemia. Physician orders for antihyperglycemic therapy should be written and, if necessary, be revised so as to respond to the presence of predisposing conditions for hypoglycemia. A ward-based protocol or hospital-wide policy should establish the appropriate response to triggering events. Within the time frame of action of previously administered antihyperglycemic drugs (after abrupt interruption of caloric exposure), the threshold for preventive intravenous administration of dextrose is a glucose concentration of 120 mg/dL.
Braithwaite
Susan S
SS
University of North Carolina, Chapel Hill, North Carolina, USA.
Buie
Michelle M
MM
Thompson
Cara L
CL
Baldwin
Douglas F
DF
Oertel
Maryanne D
MD
Robertson
Beverly A
BA
Mehrotra
Hetal P
HP
D006801:Humans; D007003:Hypoglycemia / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D015994:Incidence; D007297:Inpatients; D007328:Insulin / Q000627:therapeutic use; D011315:Preventive Medicine / Q000379:methods
D007004:Hypoglycemic Agents; D007328:Insulin