Hypoglycaemia: a major biochemical complication in eclampsia- its risk factors and prognostic value

In this two year prospective study, random blood glucose levels were determined in 52 eclamptic patients and 38 controls, at the University of Maiduguri Teaching Hospital and Specialist Hospitals in Maiduguri, Nigeria. Eclamptic mothers had lower glucose levels (mean value = 3.5 mmol/l) than controls (mean value = 6.8 mmol/l) (P < 0.001). Nineteen eclamptics (36.5%) had hypoglycaemic glucose levels (mean value = 2.3 mmol/l). These values returned to normal following intravenous administration of dextrose. Risk factors for hypoglycaemia identified in these mothers included lack of antenatal care, unsupervised labour at home, labour lasting more than 14 hours, obstructed labour, maternal hyperpyrexia, convulsions four or more times, deranged liver function especially HELLP syndrome (syndrome of haemolysis, elevated liver enzymes and low platelet count), poor energy supply in labour, low socio-economic class status and anaemia. A scoring panel derived from these risk factors was tested on a separate group of 48 eclamptics and this was found to be 96% sensitive. Infusion of 50% dextrose reversed coma in seven of eight comatose eclamptics and corrected fetal heart rate irregularities in 13 of 15 hypoglycaemic eclamptics. Seven of nine patients who suffered from posteclamptic psychosis had hypoglycaemic glucose levels. Three mothers with hypoglycaemia and HELLP syndrome died after developing hyperglycaemia following infusions of 50% and 10% dextrose. Hypoglycaemia should be considered a major biochemical complication of eclampsia. Its risk should be identified and its treatment be considered in the protocol of the management of eclamptics.