title: Fictitious hyperglycemia: point-of-care glucose measurement is inaccurate during high-dose vitamin C infusion for burn shock resuscitation.
abstract: The use of high-dose vitamin C (hdVC, 66 mg/kg/hour × 18 hours) infusion is a useful adjunct to reducing fluid requirements during resuscitation of burn shock. Routine point-of-care glucose (POCG) analysis has been inaccurately high in observed patients undergoing hdVC. Inaccurate POCG could potentially lead to iatrogenic hypoglycemia if the fictitious hyperglycemia is treated with insulin. This study is a retrospective analysis of plasma glucose measurements from a central laboratory (LG) compared with POCG during and 24 hours after hdVC infusion. Records of adult patients receiving hdVC infusions during burn resuscitation over 1 year were reviewed. Charts selected for analysis included those with glucose measurements using POCG and LG that were taken simultaneously, during hdVC infusion, and 24 hours after completion. All specimens were drawn from arterial lines. POCG was measured with Accu-Chek Inform (Roche, Indianapolis, IN) and LG was measured by Siemens Dimension Vista 500 (Siemens, Deerfield, IL) using biochromic analysis. Nonparametric statistical analysis was performed using Wilcoxon's matched pairs test and Spearman correlation with significance at P < .05. Of 18 adult patients undergoing burn resuscitation with hdVC infusion, 5 were chosen for analysis (%TBSA 40 ± 15; age 51 ± 18). All data were pooled with 11 comparisons both during and after hdVC. The mean POCG (225 ± 71) was significantly higher than mean LG (138 ± 41) on hdVC (P = .002). There was no difference between POCG (138 ± 30) and LG (128 ± 23) after hdVC was finished (P = .09). There was a negative correlation between POCG and LG on hdVC (-0.64, P = .04) and a positive correlation off hdVC (0.89, P = .0005). POCG analysis during hdVC infusion is significantly higher than laboratory glucose measurements. Once the hdVC infusion is complete, POCG and laboratory glucose measurements are not statistically different. Treating erroneously high glucose based on POC testing is potentially dangerous and could lead to hypoglycemia and seizures.
authors.affiliation: From the *Department of Surgery, Division of Trauma and Surgical Critical Care, Vanderbilt University, Medical Center, Nashville, Tennessee; and †Department of Surgery, Paul Silverstein Burn Center, Integris Baptist Medical Center, Nashville, Tennessee.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Kahn
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Lentz
mesh_terms: D000328:Adult; D000368:Aged; D001205:Ascorbic Acid / Q000008:administration & dosage*; D001774:Blood Chemical Analysis / Q000379:methods; D001786:Blood Glucose / Q000032:analysis*; D002056:Burns / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D016638:Critical Illness; D003951:Diagnostic Errors / Q000517:prevention & control*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis; D007003:Hypoglycemia / Q000175:diagnosis / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems / Q000592:standards*; D012189:Retrospective Studies; D012774:Shock, Traumatic / Q000188:drug therapy* / Q000209:etiology; D014882:Water-Electrolyte Balance / Q000187:drug effects; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D001205:Ascorbic Acid