Glucagon for metabolic/endocrinologic emergencies: hypoglycaemia

Abstract

The high frequency of acute hypoglycaemia as a medical emergency has been well documented¹. Hypoglycaemia has been related to approximately 4% of the deaths of elderly diabetic patients; between 8 and 15% of insulin treated diabetics experience at least one severe hypoglycaemic episode each year^2,3,4. Excess administration of exogenous insulin or oral hypoglycaemic agents are by far the most common causes. However, severe hypoglycaemia in association with acute and chronic alcoholism, severe hepatic and renal dysfunction, endocrinologic tumours, and malnutrition are all well described^5,6,7. Although brief periods of hypoglycaemia are ordinarily well tolerated, it is clear that prolonged severe hypoglycaemia can lead to permanent neurologic sequelae, seizures and even death^8,9,10 The term hypoglycaemia, as utilized in this chapter and in much of emergency medical practice, refers to a symptom complex associated with subnormal glucose levels. Although chemical hypoglycaemia is often defined as a serum glucose level of 45 mg/dl or less, levels of 35 mg/dl or lower are asymptomatic in certain populations, particularly in women and neonates^11,12. Hypoglycaemia may be clinically classified as either mild or severe; the distinction in this case is made on the ability of the patient to self-correct the problem through the enteral route. Severe hypoglycaemia is defined as when the alteration in mental status is severe enough that parenteral therapy is required. It should be noted that severity of symptoms is related not only to the degree of depression of the serum glucose level but also to the rapidity of the fall in that level. This implies that symptomatic and even severe hypoglycaemia may occur in the presence of serum levels in the 40–80 mg/dl range¹³.

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