Hypoglycemia in Non-Diabetic In-Patients: Clinical or Criminal?

Background and Aim

We wished to establish the frequency of unexpected hypoglycemia observed in non diabetic patients outside the intensive care unit and to determine if they have a plausible clinical explanation.

Methods

We analysed data for 2010 from three distinct sources to identify non diabetic hypoglycaemic patients: bedside and laboratory blood glucose measurements; medication records for those treatments (high-strength glucose solution and glucagon) commonly given to reverse hypoglycemia; and diagnostic codes for hypoglycemia. We excluded from the denominator admissions of patients with a diagnosis of diabetes or prescribed diabetic medication. Case notes of patients identified were reviewed. We used capture-recapture methods to establish the likely frequency of hypoglycemia in non-diabetic in-patients outside intensive care unit at different cut-off points for hypoglycemia. We also recorded co-morbidities that might have given rise to hypoglycemia.

Results

Among the 37,898 admissions, the triggers identified 71 hypoglycaemic episodes at a cut-off of 3.3 mmol/l. Estimated frequency at 3.3 mmol/l was 50(CI 33–93), at 3.0 mmol/l, 36(CI 24–64), at 2.7 mmol/l, 13(CI 11–19), at 2.5 mmol/l, 11(CI 9–15) and at 2.2 mmol/l, 8(CI 7–11) per 10,000 admissions. Admissions of patients aged above 65 years were approximately 50% more likely to have an episode of hypoglycemia. Most were associated with important co-morbidities.

Conclusion

Significant non-diabetic hypoglycemia in hospital in–patients (at or below 2.7 mmol/l) outside critical care is rare. It is sufficiently rare for occurrences to merit case-note review and diagnostic blood tests, unless an obvious explanation is found.     

Arp2/3 and SCAR: plants move to the fore

The actin-nucleating Arp2/3 complex is essential for life in yeast and animals, but not in plants, in which mutants of Arp2/3 complex components show relatively minor developmental abnormalities. Animal cells control the activity of the Arp2/3 complex through the suppressor of cyclic AMP receptor (SCAR) complex to achieve cell motility. Amazingly, plants have also retained the SCAR cell-motility pathway, and now provide a unique model for the study of new aspects of SCAR function in the absence of cell motility.     

Microsomal and cytosolic cytochrome P450 mediated benzo(a)pyrene hydroxylation in Pleurotus pulmonarius

Summary Microsomal and soluble fractions of Pleurotus pulmonarius exhibited a reduced carbon monoxide difference spectrum with P450 maxima at 448nm and 450–452nm respectively. Substrate induced Type I spectra were observed on addition of benzo(a)pyrene to both fractions. Benzo(a)pyrene hydroxylation was measured using the aryl hydrocarbon hydroxylase assay and was observed to be P450 dependent as indicated by carbon monoxide inhibition together with the substrate binding characteristics. The activity of the fractions were observed to give K_m of 200mM and 660mM and V_max of 1.25 nmol/min/nmol P450 and 0.57 nmol/min/nmol P450 for the microsomal and cytosolic fractions respectively.