ACCURACY OF FINGERSTICK GLUCOSE DETERMINATION IN PATIENTS RECEIVING CPR

Recent demonstration of the dangers of hyperglycemia in the setting of cerebral hypoperfusion has resulted in recommendations to abandon the long-standing practice of empiric administration of dextrose to patie nts with altered mental status. Patients receiving basic cardiopulmona ry resuscitation (CPR) have been identified as being at particular ris k from inappropriate administration of dextrose. We conducted a prospe ctive trial to determine whether the blood glucose of 50 patients rece iving CPR could be accurately assessed using a portable rapid-reagent device in the emergency department (ED). We analyzed both capillary an d venous blood samples in the rapid-reagent system, using laboratory a nalysis of venous blood to define the patient's true blood glucose lev el. Capillary blood analysis identified 8 patients as hypoglycemic; on ly 3 of these patients were truly hypoglycemic, and 2 patients identif ied as hypoglycemic by fingerstick were actually hyperglycemic on labo ratory analysis. The only instance in which a patient was classified d ifferently by venous rapid-reagent and laboratory analysis occurred wh en a patient assessed as normoglycemic (169 mg/dL) by the laboratory h ad a venous rapid-reagent glucose reading of 182 mg/dL (hyperglycemic) . We recommend that venous (rather than capillary) blood be used to an alyze blood glucose in all patients receiving CPR before dextrose admi nistration is considered.