Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
J Emerg Med. 2023 Mar;64(3):388-390. doi: 10.1016/j.jemermed.2022.12.017. Epub 2023 Mar 1.
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.
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.
人为性低血糖是指血糖正常的患者出现低血糖检测值。休克状态或末梢灌注不足的患者可以代谢组织中更多比例的葡萄糖，而从这些组织中获得的血液中的葡萄糖浓度可能远低于中央循环中的血液。
我们介绍了一位 70 岁女性系统性硬化症患者的病例，该患者进行性功能下降，四肢发凉。她的指尖初始即时检测（POCT）血糖值为 55mg/dL，随后重复出现低 POCT 血糖读数，尽管血糖已得到补充，且外周静脉 i.v. 部位的血糖值正常。然后从她的手指和肘前窝分别进行了两次 POCT，两者的血糖读数差异很大；后者与她的 i.v. 采血结果一致。该患者被诊断为人为性低血糖。讨论了避免 POCT 样本出现人为性低血糖的其他血液来源。
为什么急诊医生应该了解这一点？：人为性低血糖是一种罕见但常被误诊的现象，当外周灌注有限时，急诊患者可能会出现这种情况。我们鼓励医生使用静脉 POCT 来确认末梢毛细血管结果，或探索其他血液来源，以避免人为性低血糖。当错误结果是低血糖时，微小的绝对误差也很重要。
