Accuracy of Reagent Strips in Detecting Hypoglycemia in the Emergency Department

doi:10.1016/S0196-0644(98)70005-8

Annals of Emergency Medicine

Volume 32, Issue 3, September 1998, Pages 305-309

Presented at the Society for Academic Emergency Medicine Annual Meeting, May 26-29, 1992, Toronto, Ontario.

https://doi.org/10.1016/S0196-0644(98)70005-8 Get rights and content

Abstract

Study objective: Although reagent strips are commonly used, their reliability to estimate blood glucose concentration and guide administration of dextrose solutions in the emergency department environment has not been proved. We determined the accuracy of visually interpreted reagent strips (Chemstrip bG, Boehringer Mannheim Corp, Indianapolis, IN) and their ability to identify hypoglycemic patients in the ED. Methods: We conducted a prospective, nonrandomized blinded clinical study of the visual estimation of blood glucose values by ED personnel using Chemstrip bG reagent strips during a 4-month period. Simultaneously obtained blood samples sent for laboratory glucose determination served as controls. The study was conducted at a large university hospital ED with an urban patient population. A convenience sample of 215 adult ED patients underwent serum glucose determination with data form completion. No study intervention was tested, although timing of administration of dextrose solutions, if given, was recorded. Results: Hypoglycemia was defined as a glucose concentration less than 60 mg/dL on standard laboratory analysis. Reagent strips identified 28 of 29 of these patients (sensitivity=97%), and 171 of 182 patients without hypoglycemia (specificity=94%, negative predictive value=99%) compared with control samples. The 1 false-negative reagent strip reading of 80 mg/dL was obtained from blood stored in a serum separator tube and had a laboratory glucose value of 39 mg/dL. Eighty-seven percent of the reagent strips were within ±60 mg/dL of the control value for the laboratory glucose reference range less than 350 mg/dL. Conclusion: Visually interpreted Chemstrip bG reagent strips provide an acceptable estimation of blood glucose concentration in the ED and are highly sensitive in detecting hypoglycemia. [Scott PA, Wolf LR, Spadafora MP: Accuracy of reagent strips in detecting hypoglycemia in the emergency department. Ann Emerg Med September 1998;32:305-309.]

Section snippets

INTRODUCTION

In patients with mental status changes, the possible adverse effects of dextrose administration in a normoglycemic or hyperglycemic individual have been considered to be insignificant compared with the possibility of prolonging a hypoglycemic episode while awaiting laboratory blood glucose determination. Some evidence now suggests that dextrose solutions may not be as harmless as previously believed, and their administration in events involving cerebral ischemia may worsen neurologic outcome.

MATERIALS AND METHODS

Any ED patient requiring an electrolyte panel (with glucose determination) was eligible for inclusion. We obtained a convenience sample of 215 adult patients from a large university hospital ED with an urban patient population during a 4-month period. The study was approved by the University of Cincinnati Medical Center institutional review board before initiation, and no outside funding for the study was obtained.

Venous blood samples were obtained from a patient either in the prehospital or ED

RESULTS

Two hundred and forty-two data forms were obtained, of which 27 (11.6%) were excluded from analysis for having incomplete information. Four additional patients were excluded from statistical analysis because the glucose reading reached the upper value of the reagent strip scale (800 mg/dL), leaving a study population of 211 patients. True hypoglycemia was arbitrarily defined as a laboratory glucose determination of 60 mg/dL or less. The Table contains summary data on the values in each

DISCUSSION

The detrimental effect of an elevated blood glucose in cerebral, spinal, and renal ischemia, in addition an increased postresuscitation mortality rate, have been well documented in animal models. 1, 2, 3, 4, 5, 6, 7 The exact mechanism for the increased neurologic damage is unknown, but probably is related to increased cellular lactic acid production. ⁸ Hypoglycemia in rats may even exert a protective effect after neurologic ischemia by lowering the amount of substrate available for lactic acid

Acknowledgements

We thank the residents, nurses, and prehospital care personnel at the University of Cincinnati Center for Emergency Care for their support and cooperation in completing this study.

References (18)

WA Pulsinelli et al.
Increased damage after ischemic stroke in patients with hyperglycemia with or without established diabetes mellitus
Am J Med
(1983)
E Melamed
Reactive hyperglycaemia in patients with acute stroke
J Neurol Sci
(1976)
RF Lavery et al.
A prospective evaluation of glucose reagent teststrips in the prehospital settings
Am J Emerg Med
(1991)
E Siemkowicz et al.
Post-ischemic come in rat: Effect of different preischemic blood glucose levels on cerebral metabolic recovery after ischemia
Acta Physiol Scand
(1980)
E Siemkowicz et al.
Clinical restitution following cerebral ischemia in hypo-, norm- and hyperglycemic rats
Acta Neurol Scand
(1978)
K Inamura et al.
Substantia nigra damage induced by ischemia in hyperglycemic rats
Acta Neuropathol
(1987)
CL Voll et al.
The effect of postischemic blood glucose levels on ischemic brain damage in the rat
Ann Neurol
(1988)
JC Drummond et al.
The influence of dextrose administration on neurologic outcome after temporary spinal cord ischemia in the rabbit
Anesthesiology
(1989)
M Chopp et al.
Global cerebral ischemia and intracellular pH during hyperglycemia and hypoglycemia in cats
Stroke
(1988)

There are more references available in the full text version of this article.

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Study Objective: The purpose of this study was to determine the prevalence of hypoglycemia and describe the clinical variables associated with hypoglycemia in children receiving resuscitation care. Methods: A cross-sectional study of consecutive children receiving resuscitation care in an emergency department was performed. Rapid glucose testing was prospectively established as one of the initial resuscitation steps, and clinical variables were obtained from a retrospective chart review. The setting was an urban children’s hospital ED (Level II trauma center) with a census of 31,000 per year and a 10% admission rate. The patient population consisted of children (birth to 20 years of age) receiving resuscitation care for altered consciousness, status epilepticus, respiratory failure, cardiac failure, and cardiopulmonary arrest. Results: Over a 1-year period, 49 nontrauma-related children received resuscitation care. Nine (18%; 95% confidence interval 8.7 to 32.2) were hypoglycemic (glucose level ≤40 mg/dL). The median time from ED presentation to rapid glucose testing was 11 minutes (range, 0 to 65 minutes). Four of the hypoglycemic children had septic shock. The mortality rate was significantly greater (P =.015) in the hypoglycemic children. Conclusion: Because hypoglycemia occurs often in children requiring resuscitation and clinical signs are often unspecific, routine rapid assessment of serum glucose is recommended. To increase physician awareness, adding “S” (sugar) to the popular mnemonic A (airway), B (breathing), and C (circulation): ABC’S is recommended. [Losek JD. Hypoglycemia and the ABC’S (sugar) of pediatric resuscitation. Ann Emerg Med . January 2000;35:43-46.]
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^☆: From the Section of Emergency Medicine, University of Michigan Medical Center, Ann Arbor, MI, ^* and the Departments of Emergency Medicine, Wright State University, Dayton, OH, ^‡ and University of Cincinnati Medical Center, Cincinnati, OH. ^§

^☆☆: Reprint no. 47/1/92839

^★: Address for reprints: Phillip A Scott, MD Section of Emergency Medicine University of Michigan Medical Center 1500 E Medical Center Drive TC B1354, Box 0303 Ann Arbor, MI 48109-0303 313-936-6284 Fax 313-936-9414 E-mail [email protected]

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Accuracy of Reagent Strips in Detecting Hypoglycemia in the Emergency Department☆,☆☆,★

Abstract

Section snippets

INTRODUCTION

MATERIALS AND METHODS

RESULTS

DISCUSSION

Acknowledgements

Am J Med

J Neurol Sci

Am J Emerg Med

Post-ischemic come in rat: Effect of different preischemic blood glucose levels on cerebral metabolic recovery after ischemia

Acta Physiol Scand

Clinical restitution following cerebral ischemia in hypo-, norm- and hyperglycemic rats

Acta Neurol Scand

Substantia nigra damage induced by ischemia in hyperglycemic rats

Acta Neuropathol

The effect of postischemic blood glucose levels on ischemic brain damage in the rat

Ann Neurol

The influence of dextrose administration on neurologic outcome after temporary spinal cord ischemia in the rabbit

Anesthesiology

Global cerebral ischemia and intracellular pH during hyperglycemia and hypoglycemia in cats

Stroke