Hypoglycemic attacks in patients admitted to a palliative care unit

Abstract

Objective: To study hypoglycemic attacks in patients admitted to a palliative care unit. Methods: We retrospectively reviewed medical records of hypoglycemic attacks near the end of hospitalization in patients admitted to our palliative care unit from July 1, 2018 to January 31, 2023. Results: Four hypoglycemic attacks were observed in 0.95% of 419 patients: the first patient with carcinoma of the pancreas, liver metastasis, and peritoneal dissemination, whose hypoglycemia was corrected with only one intravenous injection of 50% glucose and subsequently died without hypoglycemia; the second patient with carcinoma of the pancreas and duodenal stenosis, whose hypoglycemic attacks were repeated, but the patient was treated with 50–60 g/day of glucose infusion by PICC (peripherally inserted central venous catheter) without hypoglycemic attack. The third patient had uterine cancer, bone metastasis, and lung metastasis, and had only one hypoglycemic attack on the palliative care ward, after which she was treated with glucose-electrolyte infusion by a peripheral route without hypoglycemic attack. The fourth patient had peritoneal dissemination of a gastrointestinal stromal tumor (GIST), liver metastasis, and tumor-produced insulin-like growth factor (IGF)-II. The patient was admitted to the general ward due to pain and restlessness. On the seventh day of admission, he had a hypoglycemic attack and was treated with 50% glucose solution that was increased to 1680 mL/day, and he was transferred to the palliative care ward on the eighth day. The patient had problems maintaining blood glucose and fluid balance. Conclusion: Hypoglycemic attacks near the end of hospitalization in patients admitted to the palliative care ward were rare (< 1%), and most cases were not difficult to manage. However, it was difficult to achieve glycemic and fluid control in an IGF-II-producing patient, suggesting the importance of balancing glycemic and fluid management while taking the patient’s prognosis into consideration.