title: Root causes of intraoperative hypoglycemia: a case series.
abstract: OBJECTIVE
  To describe the root causes of intraoperative hypoglycemic events.
  
  
  METHODS
  Retrospective analysis.
  
  
  METHODS
  Large academic teaching hospital.
  
  
  METHODS
  Data from 80,379 ASA physical status 1, 2, 3, 4, and 5 surgical patients were reviewed. Blood glucose values, insulin, oral hypoglycemic medication doses, and doses of glucose or other medications for hypoglycemia treatment were recorded.
  
  
  RESULTS
  Hypoglycemia in many patients had multiple etiologies, with many cases (8 of 17) involving preventable errors. The most common root causes of hypoglycemia were ineffective communication, circulatory shock, failure to monitor, and excessive insulin administration.
  
  
  CONCLUSIONS
  Intraoperative hypoglycemia was rare, but often preventable. Better communication among providers and between providers and patients may reduce the number of intraoperative hypoglycemic events. Many transient episodes of hypoglycemia did not result in any apparent complications, rendering their clinical importance uncertain. Critically ill patients in circulatory shock represent a group that may require close glucose monitoring.
authors.affiliation: Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA. Eric.Schwenk@jefferson.edu
authors.forename: Eric S
authors.initials: ES
authors.lastname: Schwenk
authors.forename: Boris
authors.initials: B
authors.lastname: Mraovic
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Maxwell
authors.forename: Gina S
authors.initials: GS
authors.lastname: Kim
authors.forename: Jesse M
authors.initials: JM
authors.lastname: Ehrenfeld
authors.forename: Richard H
authors.initials: RH
authors.lastname: Epstein
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose; D003142:Communication; D016638:Critical Illness; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology*; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects; D007432:Intraoperative Period; D008297:Male; D019300:Medical Errors / Q000009:adverse effects*; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D010817:Physician-Patient Relations; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000150:complications; D012772:Shock, Septic / Q000150:complications
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin