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A list with a memory, see similar case to Robin's:
 
http://www.jiscmail.ac.uk/cgi-bin/webadmin?A2=ind02&L=ACB-CLIN-CHEM-GEN&P=R43777&I=-3&m=6935
 
Laboratory tests including dip stick pathology, do have side effects that could harm patients. Unfortunately clinicians are not aware of this and when it happens they see it as an interesting clinical incident worthy of reporting to medical journals.
 
Mohammad

Robin Marks <[log in to unmask]> wrote:
 
We had a case a few years ago in a child who was severely ill with diabetic ketoacidosis. The capillary blood glucose measured by glucose meter was normal but the venous glucose (taken shortly afterwards) was markedly elevated. This can happen in any circumstance where there is peripheral circulatory shutdown, for example in cases of shock due to blood loss. In these cases capillary blood glucose is liable to be misleading low compared to venous blood glucose.

Dr R.P.M. Marks
Consultant Chemical Pathologist
Pathology
Calderdale Royal Hospital
Halifax
HX3 0PW

-----Original Message-----
From: Clinical biochemistry discussion list [mailto:[log in to unmask]]OOn Behalf Of Tetlow Lesley (RW3) CM&MC Manchester
Sent: 20 October 2005 16:40
To: [log in to unmask]
Subject: FW: Bedside glucose testing

Dear Colleagues

 

Please see attached an e-mail I received from the Clinical Director of our ICU.  Our Point of Care coordinator has also been approached by the A and E department who have expressed similar concerns.

 

Obviously we are aware of the MHRA safety notice and instrument manufacturers’ guidelines but what is the extent of the problem?  Could a capillary glucose in the hypoglycaemic range actually equate to a hyperglycaemic venous glucose?  If not then the risk of withholding glucose in a hypoglycaemic patient is far greater than any risk of administering it to a euglycaemic patient.  I am assured that there are National Intensive Care/Resus guidelines which indicate that a POC glucose should be measured in this clinical situation.

 

We have only just (believe it or not!) moved from manual BM Stix to Abbott PCx meters so this problem has only just come under my jurisdiction.  But surely other labs must have already faced it?  What do your ICUs do?  Are there any good papers or reviews you can point me to?

 

Thanks

 

Lesley

 

-----Original Message-----
From: Fortune Peter-Marc (RW3) CM&MC Manchesteer
Sent: 11 October 2005 17:02
To: Tetlow Lesley (RW3) CM&MC Manchester
Cc: Postlethwaite Robert (RW3) CM&MC Manchester; Brennan Alison (RW3) CM&MC Manchester; Darley Pete (RW3) CM&MC Manchester; Kelsey Anna (RW3) CM&MC Manchester
Subject: Bedside glucose testing

 

Lesley

 

It was brought to my attention today during a mock arrest exercise that the ward staff have been advised not to use the new glucometers when patients are shocked or septic.

 

When a child collapses it is of fundamental importance that we are able to check a blood glucose at the bedside - a lab glucose is not quick enough to guide appropriate clinical interventions.

 

Pete Darley (Resus Officer) has discussed this with Carol Chadwick who informed him this affects all types of blood glucose testing kits and has kindly supplied us with a copy of MDA SN9616 regarding this subject.

 

From reading this document I understand that there is a risk of inaccurate results - unfortunately it does not give any indication of how the results may be affected.

 

My major concern is that we must be able to urgently establish the blood glucose of a collapsed child primarily to exclude hypoglycaemia. Therefore if the test may occasionally give a false undereading of 10-20% this is irrelevant and the test should still be done. If it may give and overeading we need to elevate the accepted level at which we treat hypoglycaemia to avoid missing treating some patients.

 

It is vital we urgently establish this information to see if we need to change our treatment thresholds and advise the wards that they CAN use the glucometers in collapsed patients.

 

I would be very grateful if you could respond asap as I fear this is an accident waiting to happen

 

Peter-Marc Fortune

 

Peter-Marc Fortune
Clinical Director of Critical Care, Children's Division
Central Manchester & Manchester Children's University Hospitals NHS Trust,
Royal Manchester Children's Hospital,
Hospital Road,
Pendlebury,
Manchester M27 4HA

Phone: 0161 922 2468

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------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content.

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Dr. M A Al-Jubouri
Consultant Chemical Pathologist

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