title: Hypoglycemia in non-diabetic in-patients: clinical or criminal?
abstract: OBJECTIVE
  We wished to establish the frequency of unexpected hypoglycemia observed in non diabetic patients outside the intensive care unit and to determine if they have a plausible clinical explanation.
  
  
  METHODS
  We analysed data for 2010 from three distinct sources to identify non diabetic hypoglycaemic patients: bedside and laboratory blood glucose measurements; medication records for those treatments (high-strength glucose solution and glucagon) commonly given to reverse hypoglycemia; and diagnostic codes for hypoglycemia. We excluded from the denominator admissions of patients with a diagnosis of diabetes or prescribed diabetic medication. Case notes of patients identified were reviewed. We used capture-recapture methods to establish the likely frequency of hypoglycemia in non-diabetic in-patients outside intensive care unit at different cut-off points for hypoglycemia. We also recorded co-morbidities that might have given rise to hypoglycemia.
  
  
  RESULTS
  Among the 37,898 admissions, the triggers identified 71 hypoglycaemic episodes at a cut-off of 3.3 mmol/l. Estimated frequency at 3.3 mmol/l was 50(CI 33-93), at 3.0 mmol/l, 36(CI 24-64), at 2.7 mmol/l, 13(CI 11-19), at 2.5 mmol/l, 11(CI 9-15) and at 2.2 mmol/l, 8(CI 7-11) per 10,000 admissions. Admissions of patients aged above 65 years were approximately 50% more likely to have an episode of hypoglycemia. Most were associated with important co-morbidities.
  
  
  CONCLUSIONS
  Significant non-diabetic hypoglycemia in hospital in-patients (at or below 2.7 mmol/l) outside critical care is rare. It is sufficiently rare for occurrences to merit case-note review and diagnostic blood tests, unless an obvious explanation is found.
authors: Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, United Kingdom. k.nirantharan@bham.ac.uk
authors: Krishnarajah
authors: K
authors: Nirantharakumar
authors: Tom
authors: T
authors: Marshall
authors: James
authors: J
authors: Hodson
authors: Parth
authors: P
authors: Narendran
authors: Jon
authors: J
authors: Deeks
authors: Jamie J
authors: JJ
authors: Coleman
authors: Robin E
authors: RE
authors: Ferner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose; D003920:Diabetes Mellitus / Q000097:blood / Q000401:mortality; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000097:blood* / Q000401:mortality; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged
chemical_list: D001786:Blood Glucose