Hypoglycemia in hospitalized adult patients without diabetes

To study hypoglycemia in hospitalized patients without diabetes and to assess the role of underlying illness in th development of hypoglycemia and its association with outcome.

We undertook a retrospective review of medical records at a university-affiliated tertiary care teaching hospital to identify adult patients without diabetes, admitted between 1994 and 2002, who presented with a blood glucose level of < or =50 mg/dL (< or =2.8 mmol/L).

We identified 88 patients (51 men and 37 women) who fulfilled the inclusion criteria. The mean age of the study group was 64 years. Specific contributing comorbid illnesses that could cause hypoglycemia were found in 63 patients (72%), 24 (38%) of whom had more than one comorbid condition. Chronic renal failure was found in 22 patients (25%); alcohol intoxication was present in 13 patients (15%); and liver failure, sepsis, cancer, and endocrine disorders each accounted for 11 cases of hypoglycemia (12%). Of the 88 patients, 14 (16%) died. These patients were significantly older than those who survived: mean age, 75.4 versus 61.8 years, respectively (P = 0.034). Only 2 of 51 patients with a single episode of hypoglycemia died, in comparison with 12 of 37 patients with more than one hypoglycemic episode (P = 0.001).

Hypoglycemia in patients without diabetes is associated with a high mortality rate. This study of hospitalized adult patients without diabetes who had low blood glucose levels extends the observation that hypoglycemia is associated with major comorbid conditions. Thus, hypoglycemia is a marker for poor outcome and a signal to the clinician to search for underlying illnesses.