Published:December 18, 2022DOI:



      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


      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.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Kesavadev J
        • Misra A
        • Saboo B
        • et al.
        Blood glucose levels should be considered as a new vital sign indicative of prognosis during hospitalization.
        Diabetes Metab Syndr. 2021; 15: 221-227
        • Frye KL
        • Adewale A
        • Martinez Martinez CJ
        • Mora Montero C
        Cognitive errors and risks associated with provider handoffs.
        Cureus. 2018; 10: e3442
        • Elmqvist C
        • Fridlund B
        • Ekebergh M.
        More than medical treatment: the patient's first encounter with prehospital emergency care.
        Int Emerg Nurs. 2008; 16: 185-192
        • McGuire EA
        • Helderman JH
        • Tobin JD
        • Andres R
        • Berman M.
        Effects of arterial versus venous sampling on analysis of glucose kinetics in man.
        J Appl Physiol. 1976; 41: 565-573
        • Field JB
        • Williams HE.
        Artifactual hypoglycemia associated with leukemia.
        N Engl J Med. 1961; 265: 946-948
        • Tarasova VD
        • Zena M
        • Rendell M.
        Artifactual hypoglycemia: an old term for a new classification.
        Diabetes Care. 2014; 37: 85-86
        • Das S
        • Maiti A.
        Acrocyanosis: an overview.
        Indian J Dermatol. 2013; 58: 417-420
        • Brand FN
        • Larson MG
        • Kannel WB
        • McGuirk JM.
        The occurrence of Raynaud's phenomenon in a general population: the Framingham Study.
        Vasc Med. 1997; 2: 296-301
        • Atkin SH
        • Dasmahapatra A
        • Jaker MA
        • Chorost MI
        • Reddy S.
        Fingerstick glucose determination in shock.
        Ann Intern Med. 1991; 114: 1020-1024
        • Lee KT
        • Abadir PM.
        Failure of glucose monitoring in an individual with pseudohypoglycemia.
        J Am Geriatr Soc. 2015; 63: 1706-1708
        • Bishay R
        • Suryawanshi A.
        Artifactual hypoglycaemia in systemic sclerosis and Raynaud's phenomenon: a clinical case report and short review.
        Case Rep Endocrinol. 2016; 2016: 1-4
        • Drenthen LCA
        • Verheggen RJHM
        • De Galan BE.
        Clinical impact of artifactual hypoglycaemia and its diagnosis at the bedside.
        Rheumatol (United Kingdom). 2019; 58: 1691-1692