Frequent hypoglycemic episodes in the treatment of patients with diabetic ketoacidosis

Michael L. Malone, Steven E. Klos, Virginia M. Gennis, James Goodwin

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background. - Previous studies of the management of diabetic ketoacidosis have noted a wide range of incidence of hypoglycemia but have not studied the risk factors associated with it. Methods. - To describe the incidence of hypoglycemia in patients hospitalized with diabetic ketoacidosis, we retrospectively reviewed the charts of all adult patients with the diagnosis of diabetic ketoacidosis at three private, community hospitals in Milwaukee, Wis, between January 1, 1987, and May 31, 1990. Two hundred twenty admissions in 150 patients met our inclusion criteria. Results. - In 30% (66/220) of cases of diabetic ketoacidosis, a serum glucose level or Accu-Chek (Boehringer-Mannheim, Indianapolis, Ind) finding was 2.7 mmol/L or less during the first 14 days of hospitalization. No factors could be identified that were associated with a significantly increased risk of early hypoglycemia (within the first 48 hours of admission). The risk of a "late" occurrence of hypoglycemia (after 48 hours of hospitalization) was increased by fever (relative risk, 2.05; 95% confidence interval [Cl], 1.16 to 3.63), "nothing orally" status (relative risk, 3.01; 95% Cl, 1.88 to 4.83), hepatic disease (relative risk, 2.56; 95% Cl, 1.39 to 4.70), and renal disease (relative risk, 2.07; 95% Cl, 1.26 to 3.39). A logistic regression analysis snowed "nothing orally" status to be associated with an increased risk of any hypoglycemia occurring during the hospitalization (relative risk, 2.39; 95% Cl, 1.63 to 3.51). Physicians and nurses documented the first episode of hypoglycemia in their notes 45.5% and 80.3% of the time, respectively. Conclusion. - Hypoglycemia is still a common complication of diabetic ketoacidosis, is associated with hepatic and renal disease as well as fever and "nothing orally" status, and is not documented well in physician notes.

Original languageEnglish (US)
Pages (from-to)2472-2477
Number of pages6
JournalArchives of Internal Medicine
Volume152
Issue number12
StatePublished - 1992
Externally publishedYes

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Diabetic Ketoacidosis
Hypoglycemic Agents
Hypoglycemia
Hospitalization
Therapeutics
Fever
Physicians
Kidney
Private Hospitals
Liver
Incidence
Community Hospital
Logistic Models
Nurses
Regression Analysis
Confidence Intervals
Glucose

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Frequent hypoglycemic episodes in the treatment of patients with diabetic ketoacidosis. / Malone, Michael L.; Klos, Steven E.; Gennis, Virginia M.; Goodwin, James.

In: Archives of Internal Medicine, Vol. 152, No. 12, 1992, p. 2472-2477.

Research output: Contribution to journalArticle

Malone, Michael L. ; Klos, Steven E. ; Gennis, Virginia M. ; Goodwin, James. / Frequent hypoglycemic episodes in the treatment of patients with diabetic ketoacidosis. In: Archives of Internal Medicine. 1992 ; Vol. 152, No. 12. pp. 2472-2477.
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abstract = "Background. - Previous studies of the management of diabetic ketoacidosis have noted a wide range of incidence of hypoglycemia but have not studied the risk factors associated with it. Methods. - To describe the incidence of hypoglycemia in patients hospitalized with diabetic ketoacidosis, we retrospectively reviewed the charts of all adult patients with the diagnosis of diabetic ketoacidosis at three private, community hospitals in Milwaukee, Wis, between January 1, 1987, and May 31, 1990. Two hundred twenty admissions in 150 patients met our inclusion criteria. Results. - In 30{\%} (66/220) of cases of diabetic ketoacidosis, a serum glucose level or Accu-Chek (Boehringer-Mannheim, Indianapolis, Ind) finding was 2.7 mmol/L or less during the first 14 days of hospitalization. No factors could be identified that were associated with a significantly increased risk of early hypoglycemia (within the first 48 hours of admission). The risk of a {"}late{"} occurrence of hypoglycemia (after 48 hours of hospitalization) was increased by fever (relative risk, 2.05; 95{\%} confidence interval [Cl], 1.16 to 3.63), {"}nothing orally{"} status (relative risk, 3.01; 95{\%} Cl, 1.88 to 4.83), hepatic disease (relative risk, 2.56; 95{\%} Cl, 1.39 to 4.70), and renal disease (relative risk, 2.07; 95{\%} Cl, 1.26 to 3.39). A logistic regression analysis snowed {"}nothing orally{"} status to be associated with an increased risk of any hypoglycemia occurring during the hospitalization (relative risk, 2.39; 95{\%} Cl, 1.63 to 3.51). Physicians and nurses documented the first episode of hypoglycemia in their notes 45.5{\%} and 80.3{\%} of the time, respectively. Conclusion. - Hypoglycemia is still a common complication of diabetic ketoacidosis, is associated with hepatic and renal disease as well as fever and {"}nothing orally{"} status, and is not documented well in physician notes.",
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