Hypoglycemic and hyperglycemic patients in emergency room
N. Yucel, A. Sertkaya & S. Pepele
Aims: To evaluate the process of patients from emergency room (ER) admittance until discharge from the endocrinology service (ES) with hypoglycemia or hyperglycemia.
Methods: Two hundred twenty two patients either with hypoglycemia or hyperglycemia were evaluated. Hyperglycemic patients were divided into three groups: Patients with type 1 diabetes, type 2 diabetes and patients without diabetic history. The complaints, laboratory findings, stay in ER, stay in the ES and mortality rates were documented.
Results: Fatigue like unspecified complaints were the most common finding in whole hyperglycemic patients (n=206, age=59.7±16.1 yrs, glucose 291±195.7 mg/dl). Mean stay in ER was 2.91±1.77 hours, 9.3±13.2 days in ES. Mortality rate was 7.6% in whole hyperglycemics with the highest ratio in the patients without any diabetic history (13%). Hypoglycemic patients (n=16, 15 with type 2 DM, age=66.5±19 yrs, glucose 28.5±7.5 mg/dl) were found to be mostly presented with conscious deterioration (80%). Their mean stay in ER was 2.5±0.7 hours, 2.6±0.7 days in ES. The frequency of type 2 diabetes was 76% and stress hyperglycemia was 17.5%.
Conclusion: 1- The short duration for both ER and ES stay (2.5 -3 hours) is the result of our high hospitalization (70%) rates. 2- The guidelines for diabetes lead us to manage these patients with shorter stay. 3- The necessity for diagnose and defining management protocols cause to expend much time on patients without diabetic history regards of hospitalization process. The mortality rates for these patients are higher as well. 4- The high percentage (76%) of type 2 DM -either with hypoglycemia or hyperglycemia- who admitted to ER; reflects the increased frequency of the disease. 5- The increased admittance of critically ill patients to an university hospital seems to account for the increased rate of stress hyperglycemia (17.5%).
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.