Severe Hyperglycemia Does Not Have to Be Aggressively Managed in Well ED Patients

Ann Emerg Med 2016 Dec; 68:697

Retrospective study of 566 urban ED visits with initial glucose ≥400 mg/dL but not admitted to the hospital.  Hyperglycemia was the “CC” in half of the visits.

No patients had DKA or hyperosmolar symptoms.

Mean glucose at time of discharge was 334 mg/dL with wide range (48 to 694 mg/dL), nine patients had iatrogenic HYPOglycemia during the ED stay.

Discharge glucose level was NOT associated with 7-day risk for repeat ED visit or hospitalization; furthermore, levels ≥350 were not any riskier than lower levels.

Take-home point:  Blood glucose does not have to be lowered substantially in the ED in hyperglycemic patients, so long as they aren’t in DKA or hyperosmolar hyperglycemic state and are well enough to go home.

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