Causes, management and morbidity of acute hypoglycaemia in adults requiring hospital admission

In the community, acute hypoglycaemia is commonly caused by therapies fordiabetes mellitus or the excessive consumption of alcohol. Although mostepisodes do not require admission to hospital, little information isavailable on the causes and outcome of those that do. We retrospectivelysurveyed adult patients admitted to a large urban teaching hospital withacute hypoglycaemia in a 12-month period, identifying 56 admissions of 51patients. Forty-one had diabetes mellitus, 33 (80%) of whom were receivingtreatment with insulin. The others had hypoglycaemia induced by excessiveconsumption of alcohol or by deliberate self-poisoning with insulin. Ahistory of psychiatric illness and/or chronic alcoholism was common.Neurological manifestations of hypoglycaemia were the principal reason foradmission, observed on 50 occasions (89%), and 11 events (20%) hadprecipitated convulsions. Although many patients (59%) had receivedtreatment for hypoglycaemia before admission, hypoglycaemia recurred in 16%of patients in hospital. Four patients (7%) died following admission, butin only one case was this the direct result of hypoglycaemia. However,within 15 months of the index hypoglycaemia event, a further six patients(11%) had died, mostly of causes unrelated to hypoglycaemia. Patients whorequire hospital admission for treatment of hypoglycaemia have a highincidence of neurological manifestations, a high rate of mental illness andother medical disorders, and may represent a high-risk subgroup with a poorlong-term prognosis.