Fingerstick glucose determination in shock

Article Abstract:

Evaluation of the levels of blood glucose by fingerstick is rapid, inexpensive and sensitive; however, the method is subject to error in certain cases. To determine its accuracy in cases of shock (a blood pressure of less than 80), a study was carried out of 25 severely hypotensive patients (with blood pressure below this level) who were brought to an emergency department. Fingerstick capillary glucose measurements were made on these patients and on a control group of 39 patients with normal blood pressure (normotensive). All patients had glucose levels measured in three ways: by fingerstick (which measures glucose in capillary blood); by evaluation of venous blood tested with a specially prepared paper strip; and by laboratory analysis of venous blood. An acceptable correlation was found in normotensive patients between the laboratory and the other two measurements of glucose, with the venous blood results being closer to those obtained by the laboratory than the fingerstick determinations. By contrast, glucose levels as determined by fingerstick for patients in shock were only 67 percent of those measured by the laboratory or by the other test of venous blood. THis resulted in an incorrect diagnosis of hypoglycemia (abnormally low levels of blood glucose) in almost one third of the patients. When the fingerstick determination of blood sugar is relied upon, false diagnoses of hypoglycemia (abnormally low levels of glucose) might be made in patients in shock. When patients are brought to the emergency room in coma or with an altered mental status, standard procedure has been to administer high doses of glucose, as hypoglycemia is a common cause of altered mental state. Recent evidence that in certain clinical situations such high glucose levels may be deleterious have led to the recommendation that a portable meter be available to determine blood sugar levels before giving glucose. This study demonstrates that in shock, fingerstick measures of blood sugar may give falsely low results. Thus, while the portable meter may be very helpful, the blood should be obtained from a vein and not from a fingerstick. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Measurement, Physiological aspects, Blood sugar, Blood glucose, Blood sugar monitoring, Blood glucose test, Shock

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Clinical incoherence about persons: the problem of the persistent vegetative state

Article Abstract:

Modern physicians need to critically evaluate their positions on maintaining patients in the persistent vegetative state (PVS). The trend in the last century has been to encourage doctors to rely on scientific evidence for treating isolated body parts rather than on judgment calls that affect the patient as a whole person. A recent poll of neurologists and medical directors found conflicting and disturbing evidence that patients in PVS are thought of in general terms rather than as individual patients. Half of the respondents consider these patients dead but most consider a lethal injection unethical.

Care and treatment, Editorial, Ethical aspects, Right to refuse treatment, Treatment refusal, Persistent vegetative state

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