Acute and Critical Care

Original Articles

CPR/Resuscitation
Incidence of hypoglycemia in hyperkalemia patients after treatment with insulin and dextrose in the emergency department of a tertiary care hospital in India: a prospective observational study: Vivek Chaurasia, Nayer Jamshed, Praveen Aggrawal, Sanjeev Bhoi, Meera Ekka, Tej Prakash Sinha, Akshay Kumar, Prakash Ranjan Mishra, Anand Kumar Das; Acute Crit Care. 2024;39(4):499-506. Published online November 22, 2024; DOI: https://doi.org/10.4266/acc.2024.00661

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Background
Hypoglycemia is a serious, often overlooked complication of treating hyperkalemia with insulin and dextrose. If not recognized and managed, it can increase morbidity and mortality. This study aimed to estimate the incidence of hypoglycemia in hyperkalemic patients treated with 10 units of intravenous insulin, 50 ml of 50% dextrose, 10 ml of 10% calcium gluconate, and salbutamol nebulization. Additionally, the timing of hypoglycemia onset and its associated factors were studied.
Methods
This prospective observational study included hyperkalemic patients (serum potassium >5.5 mmol/L) who visited the emergency department between January 26, 2020, and August 26, 2021. The primary outcome was hypoglycemia (blood glucose <70 mg/dl) within 3 hours of receiving the standard treatment. Glucose levels were measured hourly for 3 hours. Univariate and multivariate logistic regression identified factors associated with hypoglycemia.
Results
Of 100 patients, 69% were male, and the median age was 46 years (IQR, 30–60 years). Hypoglycemia occurred in 44%, and 10% developed severe hypoglycemia (blood glucose <54 mg/dl). The median time for hypoglycemia onset was 2 hours (IQR, 1–2 hours). Low pretreatment blood glucose (<100 mg/dl) was significantly associated with hypoglycemia, according to both univariate and multivariate analyses.
Conclusions
The study found a higher incidence of hypoglycemia in hyperkalemia treatment than reported in retrospective studies, suggesting the need for standardized management protocols with integrated glucose monitoring.

Citations

Citations to this article as recorded by

Risk of hypoglycemia in hyperkalemia management with insulin among inpatients-experience in an acute care tertiary hospital
Siew Hoon Lim, Shin Yuh Ang, Siti Namira Binte Abdul Wahab, Ming Ming Teh, Fazila Aloweni
Proceedings of Singapore Healthcare.2025;[Epub] CrossRef

Consideration of Prognostic Factors in Hypoglycemic Encephalopathy: Ik Kwon Seo, Woo Ik Choi, Sang Chan Jin, Hyuk Won Chang; Korean J Crit Care Med. 2012;27(4):209-217.; DOI: https://doi.org/10.4266/kjccm.2012.27.4.209

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Abstract PDF

BACKGROUND
Recently, there are many reports about the association of Diffusion Weighted Imaging (DWI) and the prognosis of hypoglycemic encephalopathy (HE), but those relationships have not yet been completely determined. As such, we researched for prognosis, according to a variety of clinical data, and the lesion's distribution on DWI.
METHODS
We retrospectively reviewed 19 patients who were diagnosed as HE. In addition, those prognoses were analyzed by a variety of clinical data and characteristics of lesion's distribution, which were evaluated on DWI and Apparent Diffusion Coefficient (ADC) maps. Three months later, those prognoses were determined by each Modified Rankin Scale. Further, the time-dependent average Glasgow Coma Scale (GCS), among the groups according to the characteristics of lesion's distributions in the initial DWI, was estimated.
RESULTS
In this study, the difference of prognosis was not shown, according to all the clinical data, such as the severity or duration of the hypoglycemic state, but the group that did not have any pathologic lesion on the initial DWI demonstrated a better prognosis, in comparison with the groups-that exhibited any positive lesion on the initial DWI (p = 0.006). The group that had a focal pathologic lesion on the initial DWI showed a better prognosis than the diffuse lesion's group (p = 0.045). The groups with no lesion or focal lesion showed a faster recovery of GCS than the other groups with a positive lesion or diffuse lesion within the initial 1 week.
CONCLUSIONS
We can identify that the characteristics of the lesion's distribution of DWI can be more helpful to predict of prognosis in HE than a variety of clinical data, such as the severity or duration of the hypoglycemic state.

Citations

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Progress of Rehabilitation in Patients with Hypoglycemic Encephalopathy Accompanying Dysphagia and Voiding Difficulty: A Case Report
Hannae Jo, Hee-won Park, Sora Baek
Brain & Neurorehabilitation.2015; 8(2): 113. CrossRef

Case Reports

Transient Hypoglycemia-induced Hemiparesis Mimicking Stroke: A Case Report: Seong Hwa Lee, Ji Ho Ryu, Yong In Kim, Maeng Real Park, Mun Ki Min, Sun Min Hwang; Korean J Crit Care Med. 2011;26(3):181-183.; DOI: https://doi.org/10.4266/kjccm.2011.26.3.181

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Abstract PDF

Hypoglycemia is caused by poor oral intake, excessive exercise, alcohol abuse and inaccurate use of a hypoglycemic agent or insulin in patients that have history of diabetes mellitus (DM), especially in the elderly. Severe hypoglycemia has a variety of different symptoms or signs from focal neurologic deficits to severe coma, or death. It can be difficult to differentiate hypoglycemia-induced symptoms or signs, and stroke or cardiovascular disease in acute setting. Transient hypoglycemic hemiparesis is an infrequent case in the emergency department (ED), which is frequently misdiagnosed for stroke. When patients with decreased mental status or hemiparesis are admitted to the ED, a routine blood sugar test is essential. Hypoglycemic hemiparesis if unrecognized can result in permanent neurological damage. Therefore, it is important to detect hypoglycemia early and treat it appropriately.

Citations

Citations to this article as recorded by

Consideration of Prognostic Factors in Hypoglycemic Encephalopathy
Ik-Kwon Seo, Woo-Ik Choi, Sang-Chan Jin, Hyuk-Won Chang
Korean Journal of Critical Care Medicine.2012; 27(4): 209. CrossRef

Diffusion-weighted Imaging of a Patient in a Hypoglycemic Coma: A Case Report: Kwang Wook Jo, Hoon Kim; Korean J Crit Care Med. 2010;25(1):30-32.; DOI: https://doi.org/10.4266/kjccm.2010.25.1.30

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Abstract PDF

A 65-year-old woman with type 2 diabetes mellitus was found in an unresponsive state and she was admitted to our hospital. She was comatose on arrival. The bedside blood glucose level on admission was 15 mg/dl (normal range, 55-110 mg/dl). After emergency infusion with 50% dextrose, the blood glucose level rapidly normalized to 98 mg/dl, but there was no clinical improvement of her consciousness. Three days after admission, diffusion-weighted magnetic resonance imaging of the brain revealed bilateral temporal, occipital and frontal lobes lesions with high signal intensity. The patient's neurological condition did not change over the next 15 days. She died of pneumonia on the 30th day of hospitalization. DWI may be useful for detecting and making the differential diagnosis of hypoglycemic coma. Further, marked differences in the neuroimaging patterns of patients in a hypoglycemic coma are valuable prognostic predictors. We report here on a case of hypoglycemic coma with a poor outcome.

Citations

Citations to this article as recorded by

Consideration of Prognostic Factors in Hypoglycemic Encephalopathy
Ik-Kwon Seo, Woo-Ik Choi, Sang-Chan Jin, Hyuk-Won Chang
Korean Journal of Critical Care Medicine.2012; 27(4): 209. CrossRef

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