Toxic-induced hypoglycemia in clinical practice.
Toxic induced hypoglycemia is usually caused by the anti-diabetic treatment and excessive alcohol consume. Hypoglycemia in diabetics treated with insulin or anti-diabetic oral agents is far the most studied form of hypoglycemia. Less information is available on toxic-induced hypoglycemia in non-diabetic subjects with acute exogenous poisoning.


METHODS
We retrospectively studied adult non-diabetic patients admitted in Emergency Clinic Hospital of Iaşi with hypoglycemia caused by an acute poisoning, over a period of 10 years. Then we performed a prospective study in those poisoning associated with hypoglycemic risk, to assess the prevalence of toxic-induced hypoglycemia.


RESULTS
We identified 15,497 patients with acute poisoning in our retrospective study, 4,005 of whom presented poisoning associated with hypoglycemic risk (40% acute ethanol poisoning, 29% wild mushroom poisoning, 23% beta-blocker poisoning, 7% salicylate poisoning and 1% patients with anti-diabetic agents acute poisoning). The prospective study identified 1,034 patients with acute poisoning, 20.11% of whom had ethanol poisoning, 11.79% had beta-blocker poisoning, 5.89% had wild mushroom poisoning, 1.74% had salicylate poisoning and the rest of 60.47% had other acute poisoning, without hypoglycemic risk. Attempted suicide with anti-diabetic agents in non-diabetic subjects produced the most severe and prolonged form of hypoglycemia in acute poisoning. 23 patients in retrospective study and 6 patients in prospective study died, but in only one situation, the death was the direct consequence of hypoglycemia.


CONCLUSIONS
In non-diabetic subjects with acute poisoning, prevalence of toxic-induced hypoglycemia depends on the poison itself, the mechanism of poisoning, also depends on the association between toxics and the severity of toxic- induced liver disease. A useful test to assess toxic-induced hypoglycemia is standard 6 hour oral glucose tolerance test (OGTT). Factors predicting a negative outcome in toxic-induced hypoglycemia are association of toxins, cardiac and hepatic complications, and age (>65 years).
Lionte
Cătălina
C
Medical Clinic, Emergency Clinic Hospital, Gr. T. Popa University of Medicine, Iaşi, Romania. clionte@yahoo.com
Sorodoc
L
L
Laba
Victorita
V
D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000009:adverse effects; D000328:Adult; D000367:Age Factors; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D016861:Cyclooxygenase Inhibitors / Q000009:adverse effects; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced / Q000453:epidemiology / Q000209:etiology*; D007004:Hypoglycemic Agents / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009145:Mushroom Poisoning; D011446:Prospective Studies; D012189:Retrospective Studies; D012383:Romania / Q000453:epidemiology; D012423:Rural Health; D012459:Salicylates / Q000009:adverse effects; D014504:Urban Health
D000319:Adrenergic beta-Antagonists; D001786:Blood Glucose; D016861:Cyclooxygenase Inhibitors; D007004:Hypoglycemic Agents; D012459:Salicylates