Abstract
Amaç: Hipoglisemi, kan glukoz seviyesinin kişide semptom oluşturacak kadar düşmesi sonucu meydana gelen ve ciddi morbidite ve mortalite ile sonuçlanabilecek bir sendromdur. Hipoglisemi, acil servis başvurularında önemli bir yer tutmaktadır. İyi bir anamnez ve hekimin şüphesi ile tanı konulabilen hipoglisemi, hafif bir konsantrasyon kaybından bilinç kaybı ve ölüme kadar varan ciddi semptomlar arasında değişen çeşitlilikte klinik bulgulara neden olabilir. Çalışmamızda acil kliniğe başvurularında hipoglisemi tespit edilen hastaların etiyolojik yönden araştırılması amaçlandı.
Materyal ve Metod: Çalışmamıza acil servise başvurularında hipoglisemi tanıları, biyokimyasal ve hem de klinik olarak doğrulanan, 183 hasta dahil edildi. Venöz kan glukoz seviyesinin 70 mg/dl altında olması hipoglisemi olarak kabul edildi. Hamile bayanlar ve 18 yaş altı olgular çalışmamıza dahil edilmedi.
Sonuçlar: Çalışmaya 114'ü (%62,3) erkek, 69 (%37,7) kadın olmak üzere 183 hasta dahil edildi. Hastaların yaş ortalaması 55,1±27,0 yaş ve venöz kan glukoz ortalaması 44,8±7,1 mg/ dl olarak tespit edildi. Hipoglisemi etiyolojileri sırası ile diyabet 148 (%80,8), alkol kullanımı 16 (%8,8), sepsis 8 (%4,4), kanser veya kanser metastazı 7(%3,8), karaciğer sirozu zemininde gelişen hipoglisemi 2 (%1,1), addison hastası olup ilaçlarını bırakması nedeni ile 1 (0,55) ve 1 (0,55) hasta ise diabetik hasta olup insülinoma gelişmesi nedenli olarak tespit edildi. Diyabetik hastalarda en sık hipoglisemi nedeni öğün atlanması (%42,9) olarak gözlendi. Diyabetik hastalardan 49 hasta insülin, 50 hasta oral antidiyabetik ve 50 hasta ise insülin ve oral diabetik kombinasyonu kullandığı tespit edildi.
Tartışma: Hipoglisemi ciddi morbidite ve mortaliteye sebep olabilen acil bir klinik durumdur. Semptomlar bakımından oldukça zengin bir çeşitlilik içermesi, hastanın acile başvurusunda anamnez veremeyecek derecede nörolojik yönden etkilenmiş olabileceği ve yine hastanın eş zamanlı başka hastalıklara ait klinik belirti ve bulgulara sahip olabilmesi nedeni ile hastanın tanısı oldukça karmaşık hale gelebilmektedir. Bundan dolayı hipogliseminin semptomatolojisi ve acil tedavisi kadar, hastanın hipoglisemi etiyolojisi yönü ile de araştırılması gerektiğini bilmek, hastanın sonraki tedavi yaklaşımı için önem arz etmektedir.
Keywords
Supporting Institution
YOK
Project Number
YOK
References
- 1-Whipple AO. The surgical therapy of hyperinsulinismus. J Chiropr Med 1938; 3: 237–76.
- 2-Mokán M. Hypoglycaemia.Vnitr Lek. 2008;54(4):387-94.
- 3-Shafiee G, Mohajeri-Tehrani M, Pajouhi M, Larijani B. The importance of hypoglycemia in diabetic patients. J Diabetes Metab Disord 2012;11(1):17. doi:10.1186/2251-6581-11-17
- 4-Kittah NE, Vella A. Pathogenesis and management of hypoglycemia. Eur J Endocrinol 2017;177(1): 37-47. doi.org/10.1530/EJE-16-1062
- 5-Cryer PE. Symptoms of hypoglycemia, thresholds for their occurrence, and hypoglycemia unawareness. Endocrinol Metab Clin North Am 1999; 28(3):495-500, doi: 10.1016/s0889-8529(05)70084-0
- 6-Defining and reporting hypoglycemia in diabetes: a report from the American Diabetes Association workgroup on hypoglycemia. Diabetes Care. 2005;28(5):1245–9. doi:10.2337/diacare.28.5.1245.
- 7-Zammitt NN, Frier BM. Hypoglycemia in type 2 diabetes: pathophysiology, frequency, and effects of different treatment modalities. Diabetes Care 2005; 28(12):2948-61. doi: 10.2337 /diacare. 28. 12. 2948
- 8-Tesfaye N, Seaquist ER. Neuroendocrine responses to hypoglycemia. Ann N Y Acad Sci 2010;1212:12–28. doi:10.1111/j.1749-6632.2010.05820.x
- 9- Europian Medicines Agency. Guideline on clinical investigation of medicinal products in the treatment or prevention of diabetes mellitus. 2012. CPMP/ EWP/1080/00 Rev. 1.
- 10-Cryer PE, Axelrod L, Grossman AB, et al; Endocrine Society. Evaluation and management of adult hypoglycemic disorders: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2009;94(3):709-28. doi: 10.1210/jc.2008-1410.
- 11- Kumar JG, Abhilash KP, Saya RP, Tadipaneni N, Bose JM. A retrospective study on epidemiology of hypoglycemia in Emergency Department. Indian J Endocrinol Metab 2017; 21(1):119–24. doi:10.4103/2230-8210.195993
- 12- Keskin Ö, Küçükardalı Y, Kalemoğlu M. Acil servis ve hipoglisemi. Göztepe Tıp Dergisi 2004;19: 37-9
- 13-Eren SH, Caliskan HM, Kilicli F, Korkmaz I, Acibucu F, Dokmetas HS. Etiologies of patients admitted to emergency department with hypoglycemia. Sci Res Essays 2010;5:1479–82
- 14- Su CC. Etiologies of acute hypoglycemia in a Taiwanese hospital emergency department. J Emerg Med 2006;30(3):259-61. doi: 10.1016/j.jemermed.2005.05.015
- 15- Wendel CS, Fotieo GG, Shah JH, Felicetta J, Curtis BH, Murata GH. Incidence of non-severe hypoglycaemia and intensity of treatment among veterans with type 2 diabetes in the USA: a prospective observational study. Diabet Med 2014;31:1524-31
- 16- Morales J, Schneider D. Hypoglycemia. Am J Med 2014;127 (10 Suppl):17-24. doi: 10.1016/j.amjmed.2014.07.004.
- 17- Samya V, Shriraam V, Jasmine A, et al. Prevalence of hypoglycemia among patients with type 2 diabetes mellitus in a rural health center in South India. J Prim Care Community Health 2019;10:2150132719880638. doi:10.1177/2150132719880638
- 18- Ford W, Self WH, Slovis C, McNaughton CD. Diabetes in the emergency department and hospital: acute care of diabetes patients. Curr Emerg Hosp Med Rep 2013;1(1):1–9. doi:10.1007/s40138-012-0007-x
- 19-Kaufmann MA, Nelson DR, Kaushik P, Mann NC, Mitchell B. Hypoglycemia emergencies: factors associated with prehospital care, transportation status, emergency department disposition, and cost. Prehosp Emerg Care 2019;23(4):453-64. doi: 10.1080/10903127.2018.1528322.
- 20- Yun JS, Ko SH. Avoiding or coping with severe hypoglycemia in patients with type 2 diabetes. Korean J Intern Med 2015; 30(1):6–16. doi:10.3904/kjim.2015.30.1.6
- 21-Desimone ME, Weinstock RS. Non-Diabetic Hypoglycemia. In: Feingold KR, Anawalt B, Boyce A, Chrousos G, Dungan K, Grossman A, Hershman JM, et al., editors. Endotext. South Dartmouth (MA) 2000.
The examination of cases of hypoglycemia presenting to the emergency department in terms of etiology
Abstract
Aim: Hypoglycemia is a syndrome deriving from blood glucose levels falling sufficiently to produce symptoms and capable of resulting in severe morbidity and mortality. Hypoglycemia occupies an important place among emergency department presentations. It can be diagnosed through an accurate history and suspicion on the part of the physician and causes a variety of clinical findings, from mild loss of concentration to loss of consciousness and death. The purpose of this study was examine the etiologies of patients with hypoglycemia detected at presentation to the emergency department.
Material and Method: One hundred eighty-three patients wıth hypoglycemia dıagnosed during presentation to our emergency department and confirmed biochemically and clinically were included in the study. Hypoglycemia was defined as a venous blood glucose level below70 mg/dl. Pregnant women and patients aged under 18 were excluded.
Results: One hundred fourteen patients (62.3%) were men and69 (37.7%) were women. Mean age was55.1±27.0 years and mean venous blood glucose level was 44.8±7.1 mg/ dl. Hypoglycemia etiologies involved diabetes in 148 patients (80.8%), alcohol use in 16(8.8%), sepsis in eight (4.4%), cancer or cancer metastasis in seven (3.8%), hypoglycemia developing against a background of cirrhosis of the liver in two (1.1%), presence of Addison disease and medication discontinuation in one (0.55%), and insulinemia developing in a diabetic patient (0.55%). The most common cause of hypoglycemia among diabetic patients was skipped meals (42.9%). Forty-nine diabetic patients used insulin, 50 used oral antidiabetics, and 50 used a combination of insulin and oral antidiabetics.
Discussion: Hypoglycemia is an emergency clinical condition causing severe morbidity and mortality. Diagnosis may be difficult due to the wide variety of symptoms, the patient being potentially too severely neurologically affected to provide a history at presentation to the emergency department, and the possibility of simultaneous presence of clinical symptoms and findings of other diseases. Awareness that the etiology of hypoglycemia mustbe investigated in addition to the symptomatology and emergency treatment is therefore important in terms of the subsequent therapeutic approach. ,
Keywords
Project Number
YOK
References
- 1-Whipple AO. The surgical therapy of hyperinsulinismus. J Chiropr Med 1938; 3: 237–76.
- 2-Mokán M. Hypoglycaemia.Vnitr Lek. 2008;54(4):387-94.
- 3-Shafiee G, Mohajeri-Tehrani M, Pajouhi M, Larijani B. The importance of hypoglycemia in diabetic patients. J Diabetes Metab Disord 2012;11(1):17. doi:10.1186/2251-6581-11-17
- 4-Kittah NE, Vella A. Pathogenesis and management of hypoglycemia. Eur J Endocrinol 2017;177(1): 37-47. doi.org/10.1530/EJE-16-1062
- 5-Cryer PE. Symptoms of hypoglycemia, thresholds for their occurrence, and hypoglycemia unawareness. Endocrinol Metab Clin North Am 1999; 28(3):495-500, doi: 10.1016/s0889-8529(05)70084-0
- 6-Defining and reporting hypoglycemia in diabetes: a report from the American Diabetes Association workgroup on hypoglycemia. Diabetes Care. 2005;28(5):1245–9. doi:10.2337/diacare.28.5.1245.
- 7-Zammitt NN, Frier BM. Hypoglycemia in type 2 diabetes: pathophysiology, frequency, and effects of different treatment modalities. Diabetes Care 2005; 28(12):2948-61. doi: 10.2337 /diacare. 28. 12. 2948
- 8-Tesfaye N, Seaquist ER. Neuroendocrine responses to hypoglycemia. Ann N Y Acad Sci 2010;1212:12–28. doi:10.1111/j.1749-6632.2010.05820.x
- 9- Europian Medicines Agency. Guideline on clinical investigation of medicinal products in the treatment or prevention of diabetes mellitus. 2012. CPMP/ EWP/1080/00 Rev. 1.
- 10-Cryer PE, Axelrod L, Grossman AB, et al; Endocrine Society. Evaluation and management of adult hypoglycemic disorders: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2009;94(3):709-28. doi: 10.1210/jc.2008-1410.
- 11- Kumar JG, Abhilash KP, Saya RP, Tadipaneni N, Bose JM. A retrospective study on epidemiology of hypoglycemia in Emergency Department. Indian J Endocrinol Metab 2017; 21(1):119–24. doi:10.4103/2230-8210.195993
- 12- Keskin Ö, Küçükardalı Y, Kalemoğlu M. Acil servis ve hipoglisemi. Göztepe Tıp Dergisi 2004;19: 37-9
- 13-Eren SH, Caliskan HM, Kilicli F, Korkmaz I, Acibucu F, Dokmetas HS. Etiologies of patients admitted to emergency department with hypoglycemia. Sci Res Essays 2010;5:1479–82
- 14- Su CC. Etiologies of acute hypoglycemia in a Taiwanese hospital emergency department. J Emerg Med 2006;30(3):259-61. doi: 10.1016/j.jemermed.2005.05.015
- 15- Wendel CS, Fotieo GG, Shah JH, Felicetta J, Curtis BH, Murata GH. Incidence of non-severe hypoglycaemia and intensity of treatment among veterans with type 2 diabetes in the USA: a prospective observational study. Diabet Med 2014;31:1524-31
- 16- Morales J, Schneider D. Hypoglycemia. Am J Med 2014;127 (10 Suppl):17-24. doi: 10.1016/j.amjmed.2014.07.004.
- 17- Samya V, Shriraam V, Jasmine A, et al. Prevalence of hypoglycemia among patients with type 2 diabetes mellitus in a rural health center in South India. J Prim Care Community Health 2019;10:2150132719880638. doi:10.1177/2150132719880638
- 18- Ford W, Self WH, Slovis C, McNaughton CD. Diabetes in the emergency department and hospital: acute care of diabetes patients. Curr Emerg Hosp Med Rep 2013;1(1):1–9. doi:10.1007/s40138-012-0007-x
- 19-Kaufmann MA, Nelson DR, Kaushik P, Mann NC, Mitchell B. Hypoglycemia emergencies: factors associated with prehospital care, transportation status, emergency department disposition, and cost. Prehosp Emerg Care 2019;23(4):453-64. doi: 10.1080/10903127.2018.1528322.
- 20- Yun JS, Ko SH. Avoiding or coping with severe hypoglycemia in patients with type 2 diabetes. Korean J Intern Med 2015; 30(1):6–16. doi:10.3904/kjim.2015.30.1.6
- 21-Desimone ME, Weinstock RS. Non-Diabetic Hypoglycemia. In: Feingold KR, Anawalt B, Boyce A, Chrousos G, Dungan K, Grossman A, Hershman JM, et al., editors. Endotext. South Dartmouth (MA) 2000.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Original Article |
| Authors | |
| Project Number | YOK |
| Publication Date | March 26, 2020 |
| Published in Issue | Year 2020 Volume: 2 Issue: 2 |
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