Blood glucose monitoring in paediatric diabetic ketoacidosis
Date First Published:
July 17, 2009
Last Updated:
July 30, 2009
Report by:
Joanna Ibhadon, 4th year medical student (University of Manchester)
Three-Part Question:
In a [child presenting with diabetic ketoacidosis], is a [venous BM reading] accurate enough to [commence insulin therapy]?
Clinical Scenario:
A 10 year old boy comes to the Emergency Department with dehydration, polydipsia and polyuria. He is unwell. A provisional diagnosis of diabetic ketoacidosis is made. IV access is gained and fluid resuscitation is commenced. You wonder whether the venous BM reading of 25 is accurate enough to commence insulin or whether you should wait for a formal lab glucose.
Search Strategy:
Medline (1950-07/09) using the OVID interface, Cochrane (2009) and Embase (2009)
[Laboratory glucose.mp OR laboratory sample.mp] OR [Venous glucose.mp OR venous sample.mp]. LIMIT to human AND children aged 0-18 AND English language.
[Laboratory glucose.mp OR laboratory sample.mp] OR [Venous glucose.mp OR venous sample.mp]. LIMIT to human AND children aged 0-18 AND English language.
Outcome:
2163 papers were found through the databases. One paper had evidence to answer all parts of the clinical question.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Capillary versus venous bedside blood glucose estimations R Boyd, B Leigh and P Stuart 2005 Australia | Emergency Department patients aged >12 years | Case study | Correlation between capillary or venous blood glucose values and laboratory blood glucose analysis. | mean venous derived glucometer blood glucose was 7.99 mmol/l | -Small number of patients. -Mean age of the patients was above the paediatric range at 56.9years. -No power |
| Statistically significant difference (p<0.001) between mean values for laboratory and venous derived glucometer tested blood glucose (0.91 mmol/l; 95% CI 0.6 to 1.2). |
Bottom Line:
Although venous blood glucose readings taken from a glucometer are accurate, staff must exercise caution when accepting such results as equivalent or substitute for a laboratory blood glucose result.
References:
- R Boyd, B Leigh and P Stuart. Capillary versus venous bedside blood glucose estimations