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American Journal of Health-System Pharmacy, Vol. 62, Issue 7, 714-719
Copyright © 2005 by American Society of Health-System Pharmacists
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Reports

Causes of hyperglycemia and hypoglycemia in adult inpatients

Wendy D. Smith, Almut G. Winterstein, Thomas Johns, Eric Rosenberg and Brian C. Sauer

WENDY D. SMITH, PHARM.D., is Clinical Specialist in Drug Information, The Methodist Hospital, Houston, TX; at the time of this study she was Drug Information Specialty Resident, Shands Hospital at the University of Florida (SHUF), Gainesville. ALMUT G. WINTERSTEIN, PH.D., is Assistant Professor, Pharmacy Healthcare Administration, College of Pharmacy, University of Florida (UF), Gainesville. THOMAS JOHNS, PHARM.D., BCPS, is Manager of Clinical Practice Operations, SHUF. ERIC ROSENBERG, M.D., M.S.P.H., is Assistant Professor, Department of Medicine, College of Medicine, UF. BRIAN C. SAUER, PH.D., is Medical Informatics Fellow, Salt Lake City Veterans Affairs Medical Center, Salt Lake City, UT; at the time of this study Dr. Sauer was a doctoral student, Department of Pharmacy Health Care Administration, College of Pharmacy, UF.

Address correspondence to Dr. Winterstein at Pharmacy Health-care Administration, College of Pharmacy, Health Science Center, University of Florida, P.O. Box 100496, Gainesville, FL 32610 (almut{at}ufl.edu).


Purpose. The underlying causes of hyperglycemia and hypoglycemia in adult medical and surgical inpatients were studied.

Methods. Hyperglycemic and hypoglycemic events occurring in adult medical and surgical patients admitted between February and July 2003 to a tertiary care hospital were identified prospectively from automated daily printouts of abnormal blood glucose levels generated by the hospital laboratory. Information on the causes of a random sample of events was ascertained within 24 hours through chart review and provider and patient interviews. Narratives were presented to an expert committee to assess the causes of each event and preventability.

Results. Eighteen of 24 hypoglycemic events and 26 of 26 hyperglycemic episodes were considered preventable. Failure to adjust antidiabetic drugs in response to decreases in oral intake and unexpected deviation from normal hospital routine were the most common factors contributing to hypoglycemia. Hyperglycemia was most often associated with an unwillingness of providers to take responsibility for diabetes management and the exclusive use of sliding-scale insulin regimens.

Conclusion. Hyperglycemia and hypoglycemia in medical and surgical inpatients were mostly related to inadequate prescribing, monitoring, and communication practices.

Index terms: Antidiabetic agents; Communication; Diabetes mellitus; Dosage; Errors, medication; Hospitals; Hyperglycemia; Hypoglycemia; Insulin; Prescribing; Toxicity

 





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