TITLE:
Hypoglycemia in the ICU: Discrepancy between capillary and serum glucose measurements in patients with renal disease
AUTHORS:
Ruth A. Verner, Maguy Chiha, Mary Ann Emanuele, Alaleh Mazhari
KEYWORDS:
Point-of-Care; Hypoglycemia; ICU
JOURNAL NAME:
Case Reports in Clinical Medicine,
Vol.2 No.4,
July
8,
2013
ABSTRACT: Recently,
a focus on tight glycemic control in intensive care units (ICU) has resulted in
implementation of strict insulin protocols requiring frequent glucose
monitoring. The use of point-of-care (POC) capillary glucose testing is widespread,
but its validity in the ICU has been questioned. Our objective is to better
understand the use of POC glucose at the extremes of glycemic control through a
case review at our institution. We describe the case of a 75-year-old non-diabetic
female with end stage renal disease (ESRD) on
hemodialysis who was admitted with apparent hypoglycemia. After extensive
workup was done for a seemingly refractive hypoglycemia, a discrepancy between
POC capillary glucose and central serum glucose levels was discovered, revealing
actual euglycemia and false low POC glucose values. Cases of hypoglycemia can
be challenging, especially in non-diabetic patients with ESRD. While glucometers
assessing capillary glucose are used both in the outpatient and inpatient
environment, their validity in the critically ill patient has known limitations.
Cases such as this have led to the development of systemic checks and
balances, as well as further investigations regarding the use of POC glucose
meters in the ICU. This case serves as a reminder to evaluate for all causes
for abnormal laboratory values, including technological limitations.