ORIGINAL ARTICLE

The biochemical investigation of cases of hypoglycaemia: an assessment of the clinical effectiveness of analytical services

J D Teale¹, G Wark¹, V Marks²

¹ SAS Hormone Unit, Clinical Laboratory, Royal Surrey County Hospital, Guildford GU2 7XX, UK
² Post-Graduate Medical School, University of Surrey, Guildford GU2 7DJ, UK

Correspondence to:
Correspondence to:
Dr J D Teale, SAS Hormone Unit, Clinical Laboratory, Royal Surrey County Hospital, Guildford GU2 7XX, UK;
dteale{at}royalsurrey.nhs.uk

Aim: To assess the extent to which biochemical analytical services contribute to the diagnosis and management of clinical cases of hypoglycaemia.

Methods: All cases of confirmed hypoglycaemia, referred during a six month period, were included in the survey. Questionnaires were sent to each referring laboratory requesting information on the clinical progress and current status of the patient.

Results: The level of influence exerted by analytical data was assigned in each case and those with similar outcomes combined. Identifiable case groups were: (1) Results not recorded in the patients' notes (15.7%). (2) Inappropriate requesting of insulin and C peptide measurements in cases of diabetes (11.4%). (3) Patient died soon after investigation (20.0%). (4) Patient recovered spontaneously (17.1%). (5) Patient received effective medical or surgical treatment (12.9%). (6) Patient awaiting or not requiring pathology based treatment (31.4%). (7) Inconclusive outcome prompting further investigation (5.7%).

Conclusions: Within the timescale of the survey (approximately 12 months), positive progress had been made towards diagnosis and subsequent treatment in only 10% of cases. Another 30% were either awaiting some form of treatment or further diagnostic tests. The remaining 60% did not appear to benefit in any way from the biochemical investigations.

Keywords: hypoglycaemia; biochemical investigation; diagnostic effectiveness

Abbreviations: IKHH, idiopathic ketotic hypoinsulinaemic hypoglycaemia; SAS, Supraregional Assay Service

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