Abstract
Background
Artifactual hypoglycemia is a low glucose measurement in a normoglycemic patient.
Patients in a shock state or with extremity hypoperfusion can metabolize a higher
proportion of the glucose in the poorly perfused tissue, and blood obtained from those
tissues may have far lower glucose concentration than the blood in the central circulation.
Case
Report
We present the case of a 70-year-old woman with systemic sclerosis, progressive functional
decline, and cool digital extremities. The initial point-of-care testing (POCT) for
glucose was 55 mg/dL from her index finger, with subsequent repeated low POCT glucose
reading, despite glycemic repletion and contradictory euglycemic serologic readings
from her peripheral i.v. sites. Two separate POCTs were then obtained from her finger
and her antecubital fossa, which had vastly different glucose readings; the latter
was in congruence with her i.v. draws. The patient was diagnosed with artifactual
hypoglycemia. Alternative sources of blood to avoid artifactual hypoglycemia on POCT
samples are discussed. Why Should an Emergency Physician Be Aware of This? Artifactual
hypoglycemia is a rare but commonly misdiagnosed phenomenon that can occur in emergency
department patients when peripheral perfusion is limited. We encourage physicians
to confirm peripheral capillary results with a venous POCT or explore alternative
sources of blood to avoid artificial hypoglycemia. Small absolute errors can matter
when the erroneous result is hypoglycemia.
Keywords
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Article info
Publication history
Published online: December 18, 2022
Accepted:
December 13,
2022
Received in revised form:
August 17,
2022
Received:
May 23,
2022
Publication stage
In Press Uncorrected ProofFootnotes
RECEIVED: 23 May 2022; FINAL SUBMISSION RECEIVED: 17 August 2022; ACCEPTED: 13 December 2022
Identification
Copyright
Published by Elsevier Inc.
