Impact of Cyanokit Administration on Point-of-Care Glucose and Laboratory Test Accuracy.

Abstract

A 52-year-old woman was brought to a community hospital by emergency medical services after being pulled from a multistory house fire. Initial treatment included one dose of Cyanokit (5 g, hydroxocobalamin) before she was med-flighted to our institution at approximately 07:50 AM. Initial evaluation included a plasma basic metabolic panel (BMP), coagulation studies, arterial blood gas (BGAS) panel, and point-of-care (POC) whole blood glucose measurements. The clinical laboratory was contacted early in the patient’s initial presentation due to markedly discrepant and clinically significant differences in the 3 different glucose results originating from the BMP glucose, BGAS glucose, and the POC glucose. Figure 1, A illustrates the varying concentrations obtained during the initial evaluation of the patient. Notably, glucose concentrations varied greatly by the POC method, ranging from <20 to 489 mg/dL. Three measurements (indicated by X), two by POC and one by arterial BGAS, were suspected to be contaminated with the dextrose infusion administered to the patient. Excluding these measurements, the POC glucose results ranged from 4 to 173 mg/dL lower than the time-paired (±10 minutes) BMP plasma glucose and arterial BGAS glucose measurements (Table 1).