A Retrospective Audit Of Hypoglycaemia Presentations To The Emergency Department — ASN Events
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  3. A Retrospective Audit Of Hypoglycaemia Presentations To The Emergency Department

A Retrospective Audit Of Hypoglycaemia Presentations To The Emergency Department (#341)

Shankar Vamadevan 1 , Jeff Flack 1 , Matthew Smith 2
  1. Department of Diabetes and Endocrinology, Bankstown-Lidcombe Hospital , Sydney, NSW , Australia
  2. Emergency Department , Bankstown-Lidcombe Hospital, Sydney, NSW, Australia

Background: Hypoglycaemia is an important complication in patients with diabetes which requires urgent treatment.1 There were no local data on Emergency Department (ED) hypoglycaemia presentations for Bankstown-Lidcombe Hospital or the outcomes of such presentations.

Aim: The aim of this retrospective audit was to analyse characteristics of ED hypoglycaemia presentations, their causes and subsequent outcomes.

Methods: Demographic and clinical data on all ED patients with a discharge diagnosis of hypoglycaemia in 2014 were collected from the FirstNet and PowerChart databases, and their medical records.

Results: Of the 88 presentations audited, 87 had hypoglycaemia (BSL<4.0mmol/L) with one miscoded, (seven with two presentations). There were 45 males (51.7%), the mean±SD age was 61.2±21.0 years and mean presentation blood glucose 2.2±0.8 mmol/L. The commonest causes stated were: poor oral intake (35.6%), infections (9.2%) and unintentional insulin overdose (8.1%), with 27 (31.0%) presentations having no cause identified in the patient’s record. Twelve (13.8%) did not have known diabetes: (9 had no cause stated, 2 infection and 1 diarrhoea). Regarding outcomes, 47 (54%) were discharged from the ED and 8 (9.2%) from the Emergency Medical Unit the following day. Four (4.6%) self-discharged against medical advice. There were 15(17.2%) admitted under Endocrinology, 11(12.6%) under Geriatric Medicine and 2(2.3%) Other; (1 Cardiology, 1 Renal), with mean length of stay 13.2±10.3, 5.9±7.3 and 5.5±3.5 days respectively.  Of 35(40.2%) presentations known to Diabetes Centre staff, 11 were admitted under Endocrinology, with the endocrine service contacted for only 4 of the remaining 24 (17.0%). Overall the endocrine service was only contacted or consulted for 28/87 (32.2%), either whilst in the ED or by the admitting team. Table 1 shows therapy for those with known diabetes.

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Conclusion:

These findings suggest better documentation and better communication between service units is required. Development of a flowchart for management of hypoglycaemia presentations is under consideration.

  1. 1.Ginde AA, Espinola JA, & Camargo CA. Trends and disparities in US emergency department visits for hypoglycemia, 1993-2005. Diabetes Care, 2008 March; 31(3), 511-513.