Pseudohypoglycemia: A cause for Unreliable Finger-Stick Glucose Measurements

Khoury, Marc El; Yousuf, Farheen; Martin, Vincent T.; Cohen, Robert M.

doi:10.4158/ep.14.3.337

Cited by 23 publications

(15 citation statements)

References 6 publications

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“…Fingertips are the preferred site for blood glucose monitoring. Measurement at less painful sites, such as the forearm or the thigh has been proposed, but because of poor blood flow, equilibration with the venous blood glucose is slower at these sites, possibly leading to false value of glycemia [17].Thus, measurements at the fingertip are not accurate in states of rapid blood glucose fluctuations, so our cases emphasize that this site can be unreliable in cases of suspected microcirculatory changes. So, venous blood glucose testing may be preferred.…”

Section: Discussionmentioning

confidence: 87%

Artifactual Hypoglycaemia Associated With Cyanotic Congenital Heart Disease: a New Perspective towards Understanding

Qian¹,

Ruan²,

Sun³

et al. 2016

SJMCR

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Hypoglycemia remains an infrequently and potentially dangerous complication in all patients. Patients who are suspected of having hypoglycemia should be questionable until confirmed by appropriate tests. Herein, we report clinical findings of three cyanotic congenital heart disease cases diagnosed artifactual hypoglycaemia, including an updated review of literature of artifactual hypoglycaemia. The cyanotic congenital heart disease led to secondary erythrocytosis, which provided the high levels of erythrocytes that we believe caused the artifactual hypoglycemia in combination with delayed processing of the sample. Currently, there are few specific studies on cyanotic congenital heart disease cases diagnosed artifactual hypoglycaemia. The report of our cases and the literature review underline the unnecessary of a detailed work-up for artifactual hypoglycaemia can be avoided if it is suspected in patients with cyanotic congenital heart disease. Clinicians should consider potential discrepancy in asymptomatic individuals before initiating costly examination. Our paper may represent the tip of the iceberg and raises concerns about the proper management of individuals with artifactual hypoglycaemia in cyanotic congenital heart disease.

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Section: Discussionmentioning

confidence: 87%

Artifactual Hypoglycaemia Associated With Cyanotic Congenital Heart Disease: a New Perspective towards Understanding

Qian¹,

Ruan²,

Sun³

et al. 2016

SJMCR

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“…Capillary blood collection via finger-stick gives a higher incidence of hemolysis compared to blood collection via venipuncture into a syringe or Vacutainer. Pseudohypoglycemia has been reported in patients with Raynaud's phenomenon, peripheral vascular disease and shock and may result from increased glucose extraction by the tissues because of low capillary flow and increased glucose transit time (18). Furthermore, it should be noted that hemoglobin concentration in capillary blood is slightly higher than the value in venous blood (19).…”

Section: Discussionmentioning

confidence: 99%

Critical evaluation of connectivity-based point of care testing systems of glucose in a hospital environment

Floré¹,

Fiers²,

Delanghe³

2008

Clinical Chemistry and Laboratory Medicine

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“…Blood glucose values by EMS personnel were mainly taken from capillary samples, although in a minority of cases they were taken from venous and arterial lines. This may have affected the accuracy of results [18, 27]. EMS data records of current medical conditions was recorded from information of discretion of the patient or the next of kin as well from information gathered from social security card.…”

Section: Discussionmentioning

confidence: 99%

Hypoglycaemia without diabetes encountered by emergency medical services: a retrospective cohort study

Vihonen

Kuisma

Nurmi

2018

Scand J Trauma Resusc Emerg Med

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BackgroundThe current study investigates the incidence, aetiology, and outcome of hypoglycaemia of patients without diabetes in the EMS.MethodsThe study was a retrospective cohort study that utilized electronic EMS patient record system (population of one million). All patients encountered by EMS with plasma glucose ≤3.9 mmol/l from 2009 to 2015 were included in the study and hospital records were screened manually to detect possible reasons for hypoglycaemia. Data from the governmental health insurance agency for all residents in Finland was used to reveal the diabetes status of the patients. Survival of the patients was followed from Population register centre up to six years. Serious hypoglycaemia was defined as plasma glucose ≤3.0 mmol/l.ResultsFrom EMS cases with a plasma glucose measurement a total of 5467 hypoglycaemic patients without diabetes were encountered by EMS during the study period with an incidence of 1082 (CI95% 1019–1148) per 100,000 inhabitants per year, corresponding 41.6%, (CI95% 40.8–42.3) of all hypoglycaemic patients. Of those patients, 3856 [71.6%, (CI95% 70.4–72.8)] were transported to hospital and 910 [23.2%, (CI95% 22.0–24.6)] had serious hypoglycaemia. The three main diagnosis groups that appeared in the subsequent hospital treatment associated with hypoglycaemia in all transported cases without diabetes as well with serious hypoglycaemia cases were: alcohol abuse [41.2%, (CI95% 39.7–42.8) and 42.2%, (CI95% 39.0–45.4)], hypothermia [17.2%, (CI95% 16.0–18.4) and 27.4%, (CI95% 24.6–30.4)], and malnutrition [16.9%, (CI95% 15.8–18.1) and 25.1%, (CI95% 22.4–28.0)]. Mortality ranged from 0.6–65.4% depending of admission reason and increased significantly at long-term. Non-Diabetics survival was less than with diabetics, when serious hypoglycaemia was present.DiscussionThe most common possible hypoglycaemia related aetiological causes encountered in the EMS, alcohol abuse, hypothermia, and malnutrition, although frequent are often relatively benign conditions. These possible causes of hypoglycaemia can often be treated at scene or need only short hospital admissions. Hence they are not so prevalent in hospital studies.ConclusionsHypoglycaemia without diabetes is commonly observed among the hypoglycaemic EMS cases. Main causes for it are alcohol abuse, hypothermia, and malnutrition. Mortality correlated with age, higher priority dispatch codes, and plasma glucose rate in multivariate logistic regression analysis. Some of the etiological subgroups carry a markedly high mortality rate.Electronic supplementary materialThe online version of this article (10.1186/s13049-018-0480-7) contains supplementary material, which is available to authorized users.

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Pseudohypoglycemia: A cause for Unreliable Finger-Stick Glucose Measurements

Cited by 23 publications

References 6 publications

Artifactual Hypoglycaemia Associated With Cyanotic Congenital Heart Disease: a New Perspective towards Understanding

Artifactual Hypoglycaemia Associated With Cyanotic Congenital Heart Disease: a New Perspective towards Understanding

Critical evaluation of connectivity-based point of care testing systems of glucose in a hospital environment

Hypoglycaemia without diabetes encountered by emergency medical services: a retrospective cohort study

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