Cold Fingers, False Numbers: A Case Report on Fingerstick Artefactual Hypoglycemia

Document Type

Abstract

Publication Date

Fall 10-1-2024

Abstract

Artifactual hypoglycemia, characterized by discrepancies between capillary and plasma glucose levels, can lead to unnecessary testing and interventions. Fingerstick testing, a common method for blood glucose monitoring, may yield misleading results. We report a case highlighting the clinical implications of fingerstick artefactual hypoglycemia. A 93-year-old female, with multiple comorbidities, including severe malnutrition and cool digital extremities, was admitted after a motor vehicle accident. Subsequent diagnosis revealed sepsis due to acute cystitis. Throughout her hospitalization, the patient consistently displayed low blood sugar readings exclusively in fingerstick tests. Despite a lack of prior history of diabetes or hypoglycemia, clinical examination uncovered cold and cyanosed fingertips. At bedside, point-of-care testing (POCT) for glucose from the patient's index finger yielded a concerning reading of 47 mg/dL. Surprisingly, multiple episodes of apparent hypoglycemia were measured via glucometer, with no accompanying symptoms. Simultaneous testing from the antecubital fossa yielded a contrasting reading of 84 mg/dL, aligning with plasma blood sugar. Remarkably, when POCT was performed on the heel and antecubital fossa sites, normoglycemia consistently prevailed. A 48-hour fasting test, with POCT on the patient's heel instead of fingers, revealed no hypoglycemia. Recognition of pseudo hypoglycemia in this patient was crucial, considering the septic state and cold extremities. The case underscores the importance of accurate glucose measurement sites, especially in conditions affecting micro perfusion. Healthcare providers should interpret low glucose levels measured by fingerstick with caution, considering potential limitations in patients with impaired micro perfusion. Simultaneous alternative-site testing and confirmation with venous measurements are essential for accurate diagnosis and appropriate clinical management.

Publication Title

Journal of the Endocrine Society

Volume

8

Issue

Supplement 1

First Page

A335

Last Page

A335

Link to Full Text

Open Access

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