When is inpatient care needed for acute hypoglycemia?

Updated: Dec 16, 2016
  • Author: Frank C Smeeks, III, MD; Chief Editor: Erik D Schraga, MD  more...
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Answer

Answer

Admission criteria for patients with acute hypoglycemia include the following:

  • No obvious cause

  • Oral hypoglycemic agent

  • Long-acting insulin

  • Persistent neurologic deficits

Patients with no known cause or no previous episodes of hypoglycemia must be admitted for further evaluation.

For overdose, accidental ingestion, or therapeutic misadventures with oral hypoglycemics, little correlation exists between the amount of oral hypoglycemic agent ingested and the length or depth of coma. These patients require admission.

Inadequate data are available to predict the extent or the time course of hypoglycemia in children.

Chlorpropamide has demonstrated refractory hypoglycemia for up to 6 days after ingestion. Asymptomatic patients who have ingested hypoglycemic agents should be observed for the development of hypoglycemia, because the onset of action and the half-life are extremely variable. The length of observation is based on the ingested agent.

A small pilot study by Belfort-DeAguiar et al found that inhalation of the beta-2 adrenergic receptor (AR) agonist formoterol may be effective in the prevention or treatment of acute hypoglycemia in patients with type 1 diabetes. Further studies are needed to confirm these results and long-term effects. [13, 14]

Goh et al, using criteria of successful discharge of patients from the observational ward within 24 hours and the hypoglycemia recurrence after discharge, found that selected patients can be treated effectively and safely in a 24-hour observational ward. [15] Of the 203 patients enrolled in the study, 170 were discharged, after meeting a strict set of criteria, and 33 were transferred for inpatient care. The median length of stay in the observational ward was 23 hours.

Patients were contacted at 7 and 28 days after discharge. [15] Of 151 patients contacted, 6 had recurrent hypoglycemia symptoms, 2 of whom returned to the ED and were admitted; 4 patients had mild symptoms self-managed at home. [7] Two other patients returned to the ED for conditions not related to hypoglycemia. Nineteen patients could not be contacted, but no record of a return to the ED could be found.


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