Disclosures: Rosa Rodriguez, MD, MS: Nothing to disclose

Case Description: The patient was admitted to inpatient rehabilitation following a cardioembolic right middle cerebral artery stroke and revascularization procedures for ischemic left foot pain. There, she was noted to have repeated episodes of critical hypoglycemia readings obtained via finger-stick, the lowest being 18 mg/dL.

Setting: Inpatient neuro-rehabilitation unit.

Patient: A 74-year-old woman with history of atrial fibrillation, toe amputations and diabetes mellitus.

Assessment/Results: During each episode, she was assessed and was without signs or symptoms of hypoglycemia. She received intravenous dextrose on multiple occasions, with mild subsequent rises in capillary blood glucose values. After a discrepancy was noted between a finger stick reading and a serum blood glucose obtained through venipuncture, capillary blood glucoses were instead obtained from the ear. These readings correlated with those obtained through venipuncture and remained within normal limits through the remainder of her time on the rehabilitation unit.

Discussion: Glycemic control is an important component of the care for patients receiving rehabilitation following ischemic stroke. Individuals with severe peripheral vascular disease (PVD) are at risk for artefactual hypoglycemia, in which they demonstrate falsely low capillary glucose levels, despite having normal plasma glucose concentrations. Asymptomatic episodes of hypoglycemia and discrepancies with serum glucose levels obtained with venipuncture should raise suspicion for artefactual hypoglycemia. When this occurs, it is important to avoid initiating hypoglycemic protocols based on the results of blood glucoses obtained through finger stick.

Conclusion: Physiatrists should consider the possibility of artefactual hypoglycemia in patients with severe PVD with asymptomatic low blood glucose from fingerstick testing. When discrepancies exist between capillary and venous blood glucoses, one should only administer sugars if the venous reading is low, to prevent causing unnecessary hyperglycemia.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/artefactual-hypoglycemia-during-stroke-rehabilitation-a-case-report/