Korean J Intern Med.  2015 Sep;30(5):648-656. 10.3904/kjim.2015.30.5.648.

Blood electrolyte disturbances during severe hypoglycemia in Korean patients with type 2 diabetes

• Kang MY

• KMID: 2381563
• DOI: http://doi.org/10.3904/kjim.2015.30.5.648

Abstract

BACKGROUND/AIMS
To investigate abnormalities in blood electrolyte levels during severe hypoglycemia in Korean patients with type 2 diabetes mellitus (T2DM) in a clinical setting.
METHODS
Blood electrolyte levels in adult T2DM patients during severe hypoglycemia were collected from January 1, 2008 to December 31, 2012. Patients who maintained normal serum creatinine and blood urea nitrogen levels were utilized in the study. Severe hypoglycemia was defined as a condition requiring medical assistance, such as administering carbohydrates when serum glucose levels less than 70 mg/dL were observed, in conjunction with other symptoms of hypoglycemia.
RESULTS
A total of 1,068 patients who visited the emergency room with severe hypoglycemia were screened, of which 219 patients were included in this study. The incidence of abnormal levels for any electrolyte was 47%. Hypokalemia (< 3.5 mmol/L) was the most common type of electrolyte disturbance observed at 21.9%. A decrease in serum potassium levels was associated with decreases in blood glucose levels (r = 0.151, p = 0.025). During severe hypoglycemia, median blood glucose levels, incidence of tachycardia (> 100 beats per minute) and severe hypertension (> or = 180/120 mmHg) were 30 mg/dL (range, 14 to 62) and 35 mg/dL (range, 10 to 69; p = 0.04), 18.8% and 7.2% (p = 0.02), and 20.8% and 10.2% (p = 0.05) in the hypokalemia and normokalemia groups, respectively.
CONCLUSIONS
During severe hypoglycemia, hypokalemia occurred in 21.9% of T2DM patients and was associated with tachycardia and severe hypertension. Therefore, the results suggest that severe hypoglycemia may increase cardiovascular events in T2DM.

Keyword

Severe hypoglycemia; Electrolytes; Hypokalemia; Diabetes mellitus, type 2

MeSH Terms

Aged
Aged, 80 and over
Biomarkers/blood
Blood Glucose/drug effects/*metabolism
Diabetes Mellitus, Type 2/blood/diagnosis/drug therapy/*epidemiology
Emergency Service, Hospital
Female
Humans
Hypertension/chemically induced/epidemiology
Hypoglycemia/blood/chemically induced/diagnosis/*epidemiology/therapy
Hypoglycemic Agents/adverse effects
Hypokalemia/blood/chemically induced/diagnosis/*epidemiology
Male
Middle Aged
Potassium/*blood
Republic of Korea/epidemiology
Risk Factors
Severity of Illness Index
Tachycardia/chemically induced/epidemiology
*Water-Electrolyte Balance/drug effects
Biomarkers
Blood Glucose
Hypoglycemic Agents
Potassium