At the recent Annual Convention of the American Osteopathic College of Anesthesiologists I reviewed the last decade worth of literature surrounding the peri-operative management of diabetes. One danger is intra-operative hypoglycemia with our current "point of care" (POC) measuring devices.
Factors that may interfere with POC Measurements:
1. Normal variation by POC can be as much as 15% for glucose levels < 100 (National committee for clinical laboratory standards recommendations)
2. POC Meters are Less accurate:
a. Hypo-perfused patients (Septic)
b. Hemo-dynamically unstable patients
c. Anemic Patients
3. Inaccurate sampling: Too large a sample may result in a spuriously high measurement
4. Some medications may result in inaccurate readings. See case study below
MY RECOMMENDATION:
If you ever question a POC's measurement obtain a central lab glucose level and if indicated empirically treat the patient until you have the results back. On a system level, collaborate with the lab and pharmacy to develop a process that clearly identifies things (medications etc) that may invalidate your POC measurements.
Go Save Lives
DN
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