Insulin administration to treat hyperkalemia is the most frequent iatrogenic cause of hypoglycemia cases encountered in emergency departments, according to investigators.

Chaitanya Chittieneni, BS, of Hennepin County Medical Center and University of Minnesota School of Medicine in Minneapolis, and colleagues performed a chart review of 591 adult patients with a chief complaint or emergency department diagnosis of hypoglycemia, or an emergency department glucose value of 70 mg/dL or less. In 99 (17%) of the 591 patients, the cause of hypoglycemia was iatrogenic, the investigators reported in the Western Journal of Emergency Medicine. In 61 (61%) of the 99 patients, insulin administration was the cause of hypoglycemia. In 38 patients (38%), the cause was unrecognized malnutrition.

Forty-five (74%) of the 61 patients with iatrogenic hypoglycemia following insulin administration received the treatment for hyperkalemia, whereas 15 (31%) received insulin for uncomplicated hyperglycemia, and 1 patient received insulin for diabetic ketoacidosis, according to Chittieneni’s group.

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“This study demonstrates that hypoglycemia in [emergency department] patients is commonly caused by iatrogenesis,” the authors wrote. “In particular, insulin administration for hyperkalemia and uncomplicated hyperglycemia were frequent culprits. Unrecognized malnutrition in our population, especially in the context of alcohol intoxication, was another important cause of hypoglycemia that could have been prevented by more careful care.”


Chittieneni C, Driver BE, Halverson M, et al. Incidence and causes of iatrogenic hypoglycemia in the emergency department. West J Emerg Med. 2019;30:833-837.