Blood sugar levels not linked to seizures in Patients presenting with hypoglycemia in ED: Study

Hypoglycemia is a general medical emergency characterized by low blood glucose below 70 mg/dL that may be associated with serious neurological complications, including seizures. While severe hypoglycemia is an established cause of seizures, this relationship in non-epileptic patients with hypoglycemia is still relatively less certain. This study evaluated the characteristics and frequency of seizure events in hypoglycemia patients published in Acute Medicine and Surgery. It assessed whether a previous history of epilepsy could play a significant role in hypoglycemic patients developing seizure episodes.

This was a single-center, retrospective, observational study conducted at Western Japan from January 2017 to December 2021. Participants included all patients aged 16 years and above brought to the ED with symptomatic hypoglycemia. Data were extracted for blood sugar at first presentation, seizure at presentation, and other clinical variables from the final ED diagnostic records.

The primary outcome measure was the prevalence of seizures in patients with hypoglycemia. The secondary outcomes were comparisons between the initial blood glucose levels of the two groups with and without seizures, along with the analysis of related clinical factors. The statistical analyses were done using the Mann-Whitney U-test and the Fisher exact test.

Key Findings

• Out of a total of 380 hypoglycemic patients, seizures were observed in a mere 5.0%, while all others patients failed to present with seizure activity.

• Out of the 19 cases with a seizure, 12 were male and 7 were female. The majority of them manifested as generalized in.

• The median initial blood glucose for the seizure group was 34 mg/dL; however, those in the nonseizure group exhibited initial blood glucose ranging from 37 mg/dL.

• Initial blood glucose were similar for the seizure and nonseizure groups, (P= 0.97)

• The most prominent disorder underlying seizure was reported among patients diagnosed with type 2 diabetes (n=8), type 1 diabetes (n=8), alcohol-related disease (n=2), and postgastrectomy syndrome (n=1).

• Ten out of 19 seizure patients were hospitalized in comparison to 182. out of the 361 of the patients without seizure .

• Among the group, 18 got intravenous Glucose treatment, one patient got oral treatment, and four patients were given Vitamin B1 treatment.

• Three patients were treated with Diazepam, where 2 of them were given Diazepam to control the seizure and one for the sake of seizure control before the glucose examination. And none of the patients were administered the Glucagon treatment.

• The score which was noted in the Glasgow Coma Scale was inferior in patients who had seizures (with a median, 10) as compared to those who had not presented with any seizures (with a median, 12). In a small number of cases, hospitalization was necessary; no mortality occurred in the cohort of patients with seizures.

The findings add important insight into the interplay between hypoglycemia and seizure occurrence in ED. Notably, the initial blood glucose levels of those with and without seizures did not have significant differences, suggesting probably that the severity of hypoglycemia alone might not be an adequate predictor for seizure risk. Other assumptions, like a history of epilepsy being a cardinal risk factor for seizures among hypoglycemic patients, found no strong correlation.

This study therefore shows that seizures in people with hypoglycemia are not majorly related to any history of epilepsy, and that there is no difference in the level of blood glucose between those who develop seizure conditions and those without such conditions at the time of presentation. The findings, therefore, call for further research into other determinants of seizure risk among hypoglycemic patients. Future studies with larger samples and more standardized methods for measuring glucose would be required in the management of these patients in the ED.

Reference:

Urushidani S, Tanabe M, Baek K, Miyaguchi K, Ikegami T. Seizure occurrences among hypoglycemic patients in the emergency department. Acute Med Surg. 2024;11(1):e979. doi:10.1002/ams2.979