Root causes of intraoperative hypoglycemia: a case series

J Clin Anesth. 2012 Dec;24(8):625-30. doi: 10.1016/j.jclinane.2012.04.009. Epub 2012 Oct 29.


Study objective: To describe the root causes of intraoperative hypoglycemic events.

Design: Retrospective analysis.

Setting: Large academic teaching hospital.

Measurements: Data from 80,379 ASA physical status 1, 2, 3, 4, and 5 surgical patients were reviewed. Blood glucose values, insulin, oral hypoglycemic medication doses, and doses of glucose or other medications for hypoglycemia treatment were recorded.

Main results: Hypoglycemia in many patients had multiple etiologies, with many cases (8 of 17) involving preventable errors. The most common root causes of hypoglycemia were ineffective communication, circulatory shock, failure to monitor, and excessive insulin administration.

Conclusion: Intraoperative hypoglycemia was rare, but often preventable. Better communication among providers and between providers and patients may reduce the number of intraoperative hypoglycemic events. Many transient episodes of hypoglycemia did not result in any apparent complications, rendering their clinical importance uncertain. Critically ill patients in circulatory shock represent a group that may require close glucose monitoring.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Blood Glucose
  • Communication*
  • Critical Illness
  • Female
  • Hospitals, Teaching
  • Humans
  • Hypoglycemia / etiology*
  • Hypoglycemic Agents / administration & dosage
  • Hypoglycemic Agents / adverse effects
  • Insulin / administration & dosage*
  • Insulin / adverse effects
  • Intraoperative Period
  • Male
  • Medical Errors / adverse effects*
  • Middle Aged
  • Monitoring, Intraoperative
  • Physician-Patient Relations
  • Retrospective Studies
  • Shock, Cardiogenic / complications
  • Shock, Septic / complications


  • Blood Glucose
  • Hypoglycemic Agents
  • Insulin