Common Iatrogenic Causes of Hypoglycemia, Hyperkalemia in Emergency Departments

Iatrogenic causes are relatively common in patients treated in the emergency department (ED), the most common being insulin administration for hyperkalemia and uncomplicated hyperglycemia, according to a recent study published in the Western Journal of Emergency Medicine.

Hypoglycemia is commonly caused by factors that include missing meals, wrong insulin medication, and incorrect dosing, but it can also be caused by iatrogenesis or brought about within a health care setting. Literature on iatrogenic hypoglycemia in EDs is limited; therefore, researchers wanted to determine the frequency and causes of iatrogenic hypoglycemia in an urban ED.

The retrospective, observational study was conducted in the ED of an urban level 1 trauma center that cares for approximately 100,000 patients annually. The study included adult patients with an ED chief complaint or discharge diagnosis of hypoglycemia, or any ED glucose value ≤ 70 milligrams per deciliter (mg/dL) between 2009 and 2014. Two trained abstractors independently performed a structured chart review for each identified patient with an initial glucose ≤ 50 mg/dL or initial glucose ≥ 70 mg/dL with a subsequent glucose ≤ 50 mg/dL, to determine whether the hypoglycemia was caused by iatrogenesis.

After reviewing the charts of 591 patients who met the inclusion criteria, the researchers found that 99 (17%) patients had iatrogenic hypoglycemia. The most frequent cause of this condition was insulin administration for both uncomplicated hyperglycemia and for hyperkalemia. Of these 99 patients, 61 cases of hypoglycemia were caused by insulin administration, and 38 were caused by unrecognized malnutrition.

The 61 patients with iatrogenic hypoglycemia after ED insulin administration included 45 patients that received insulin for hyperkalemia, and 15 patients that received insulin for uncomplicated hyperglycemia. One patient received insulin for diabetic ketoacidosis, and 40 of the 99 patients had diabetes, whereas 59 did not.

The study findings suggest that hypoglycemia in patients treated in the ED is commonly caused by iatrogenesis, according to the authors. Insulin administration for hyperkalemia and uncomplicated hyperglycemia were found to be the most common causes of hypoglycemia. Additionally, patients at risk of hypoglycemia in the absence of insulin, including those with alcohol intoxication or poor nutritional status, should be monitored closely in the ED.

REFERENCE

• Chittineni C, Driver B, Halverson M, et al. Incidence and Causes of Iatrogenic Hypoglycemia in the Emergency Department. Western Journal of Emergency Medicine. Published September 5, 2019. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6754198/pdf/wjem-20-833.pdf. Accessed November 5, 2019.