Pathology Associates Of Lexington, P.A.
Pathology Associates Of Lexington, P.A.
Pathology Associates Of Lexington, P.A.
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Glucose, serum & blood:

Hypoglycemia can be a medical emergency, and serious evaluation ntoward that diagnosis must include diligent effort to test the accuracy of such a diagnosis by making it conform to "Whipple's triad":

  1. appropriate symptoms: shakey, sweaty, hunger, headache.
  2. accurately documented low blood sugar test result.
  3. appropriate therapeutic relief.

As of 1998, in the evaluation of complaints of hypoglycemia, a patient could be challenged with the "high carbohydrate meal challenge". For the 5 hours following the meal, the patient is observed for symptoms and complaints & blood sample drawn when/if they happen. Test-documented hypoglycemia (<45 mg/dl) during a symptomatic episode confirms a diagnosis of "reactive hypoglycemia". If the test does not come out low, then the patient has a symptom and complaint complex that can be called "pseudohypoglycemia".

Refer to this website. Keep one lab factor carefully in mind, if the whole blood sample is delayed in having the serum separated from the blood cells and clot, the admixed white blood cells, red blood cells , and platelets continue to consume the glucose in the blood and can be a post-phlebotomy cause of the sample itself deteriorating into a hypoglycemic specimen (not neccessarily a hypoglycemic patient). In working up a hypoglycemia case, we'd suggest sufficient serum be obtained for add-on tests, the initial effort being to catch the episode of hypoglycemia and truly document it and save the residual sample. It is possible that hypoglycemia be simply one component of a complex situation. The below table (link) lists causes that suppose the case to be uncomplicated by diabetes or other glucose- or insulin-affecting disorders. We especially do not want to miss factitious vs. endogenous causes:

Table: Recognizing Hypoglycemia (low blood sugar) Causes

Hyperglycemia (elevated serum/blood glucose):

  1. secondary to "atypical antipsychotic" medications.
  2. secondary to other medications.
  3. diabetes melitis types I & II.
  4. tight glucose management (tight glycemic control) of surgical and/or hospitalized patients
  5. other

TIGHT GLYCEMIC CONTROL (tight glucose control) was identified in about 2000 and promoted in our hospital in about 2004 (note). It has been found that the use of insulin protocols to keep the patient's blood sugar from elevating in ICU, complicated inpatient illness situations, and prolonged and complicated surgeries results in a marked reduction in the death rates (mortality) and complications (morbidity) and length of stay within the hospital. As the medical community has implimented the complex means to effect tight glucose management, there continues to be (2010) flux in arriving at protocols which will work in the many varied situations from small rural hospitals 50 or less beds to massive teriary centers with over 500 beds & huge ICHs and trauma units. So, one can find reports on the web of adverse outcomes.

Gestational Diabetes Mellitis (GDM) Screening: here is a note on office based fingerstick glucose screening in our system HERE.

References:

  1. Our lab's November 1998 issue of NewsPath.
  2. Waickus CM, et. al., "Recognizing factitious hypoglycemia in the family practice setting." J Am Board Fam Pract. 1999; 12(2):133-6.
  3. e-Medicine website topic
  4. Endo-text on-line endocrinology textbook has testing protocols.

(posted 19 July 2004; latest addition 7 November 2010)

 
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