ABSTRACT
INTRODUCTION: Hypoglycemia is associated with increased mortality in the ICU. Studies have shown that modifiable causes of hypoglycemia may include antihyperglycemic medication, reduced caloric intake & change in nutrition without insulin adjustment. The primary objective of the study was to identify modifiable risk factors for hypoglycemia in our ICUs in order to decrease its incidence. METHOD(S): This was a retrospective review from July to September 2020 of adult ICU patients at a tertiary medical center with a hypoglycemic event (glucose < 80mg/dL) given intravenous rescue dextrose. Medical, surgical, cardiac & neuro ICU patients were included. Exclusion criteria were COVID-19, comfort measures & hyperkalemia. Descriptive statistics were used for statistical analysis. RESULT(S): A total of 56 out of 784 patients (median age 64;60.7% male) had 180 discrete hypoglycemic events. Common risk factors were nothing by mouth orders (NPO) at the time of the event (69.2%), a timeframe of 1900 to 0700 (64.2%), active insulin orders (48.3%), being within 24 hours of a procedure (42.8%) or 24 hours of admission (33.9%), or having AKI (42.8%), diabetes (39.3%) or sepsis (41.1%). Of the 48.3% of patients on insulin, 40% were on an insulin infusion, 39% sliding scale & 21% long-acting. As compared to weekdays, hypoglycemia occurred 37.5%, 87.5%, and 137.5% more often on weekend days, weeknights, and weekend nights, respectively. CONCLUSION(S): The most common iatrogenic risk factors for hypoglycemia in the ICU identified in this review were the initial 24 hours of ICU admission, active insulin orders and both periprocedural and NPO status. Hypoglycemia was more common overnight but this is also when daily BMPs are collected. Interventions such as dextrose-containing maintenance fluids while NPO, removal of periprocedural NPO at midnight orders, the addition of fingerstick checks to ICU admission order sets and when a patient is NPO, and cautious insulin use are warranted to help mitigate these events. This pharmacy resident project led to a multidisciplinary policy change to hold tube feeds for patients with an ET tube or trach immediately before they travel to a procedural area instead of at midnight, or 6 hours prior to procedures with planned airway interruption or NPO status needed for bowel cases.