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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.

Search Outcome

2163 papers were found through the databases. One paper had evidence to answer all parts of the clinical question.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
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).

Clinical 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

1. R Boyd, B Leigh and P Stuart Capillary versus venous bedside blood glucose estimations Emergency Medicine Journa; 2005; 22:177–179