title: A retrospective study on epidemiology of hypoglycemia in Emergency Department.
abstract: BACKGROUND
  Hypoglycemia is one among the leading causes for Emergency Department (ED) visits and is the most common and easily preventable endocrine emergency. This study is aimed at assessing the incidence and elucidating the underlying causes of hypoglycemia.
  
  
  METHODS
  A retrospective, observational study which included patients registering in ED with a finger prick blood glucose ≤60 mg/dl at the time of arrival. All patients aged above 15 years with the above inclusion criteria during the period of August 2010 to July 2013 were selected. The study group was categorized based on diabetic status into diabetic and nondiabetic groups.
  
  
  RESULTS
  A total of 1196 hypoglycemic episodes encountered at the ED during the study period were included, and of which 772 with complete data were analyzed. Underlying causes for hypoglycemia in the diabetic group (535) mainly included medication related 320 (59.81%), infections 108 (20.19%), and chronic kidney disease 61 (11.40%). Common underlying causes of hypoglycemia in nondiabetic group (237, 30.69%) included infections 107 (45.15%), acute/chronic liver disease 42 (17.72%), and malignancies 22 (9.28%). Among diabetic subjects on antidiabetic medications (n= 320), distribution over 24 h duration clearly reported two peaks at 8thand 21sth. The incidence of hypoglycemia and death per 1000 ED visits were 16.41 and 0.73 in 2011, 16.19 and 0.78 in 2012, 17.20 and 1.22 in 2013 with an average of 16.51 and 0.91, respectively.
  
  
  CONCLUSIONS
  Bimodal distribution with peaks in incidences of hypoglycemic attacks at 8thand 21sth based on hourly distribution in a day can be correlated with the times just before next meal. None of the patients should leave ED without proper evaluation of the etiology of hypoglycemia and the problem should be addressed at each individual level. Increasing incidence of death over the years is alarming, and further studies are needed to conclude the root cause.
authors.affiliation: Department of Emergency Medicine and Trauma, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Tamil Nadu, India.
authors.forename: Juvva Gowtham
authors.initials: JG
authors.lastname: Kumar
authors.affiliation: Department of Accident and Emergency Medicine, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: K P P
authors.initials: KP
authors.lastname: Abhilash
authors.affiliation: Department of General Medicine, Kanachur Institute of Medical Sciences, Mangalore, Karnataka, India.
authors.forename: Rama Prakasha
authors.initials: RP
authors.lastname: Saya
authors.affiliation: Department of Clinical Pharmacology, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Neeha
authors.initials: N
authors.lastname: Tadipaneni
authors.affiliation: Data Analytics Consultant, Bengaluru, Karnataka, India.
authors.forename: J Maheedhar
authors.initials: JM
authors.lastname: Bose
keywords: Diabetes; Emergency Department; etiology; hypoglycemia