I guess this can be kind of a case study, if you will.
A coworker of mine was taking care of a patient (we'll call her Mrs. X). Mrs. X is day of surgery from some type of joint arthroplasty. Estimated blood loss
Mrs. X has no medical history whatsoever besides severe arthritis. Bone on bone, etc etc.
Mrs. X is lying in bed receiving D5NS0.9 @ 125 CC per hour through a 20ga IV on the dorsal side of her left hand.
The phlebotomist showed up to draw a CBC/Chem7/INR/PT...the standard stuff.
About 15 minutes after the phlebotomist left, the lab called and said Mrs. X had several critical lab values.
WBC 2.3
HGB 5.1
Glucose 821
And some others...I can't remember offhand. Those were the biggies.
Upon assessment, Mrs. X is lying in bed. Cap refill
My coworker is at this point flipping out because the glucose is 821. She pages the physician. Physician went monkey over the phone, but ordered a stat redraw. In the meantime, my coworker is prepping to send this patient to the ICU. Physician is freaking out whereever he is, and is calling for updates every 2 minutes.
Between the time the phlebotomist left and the time the original labs were phoned to us, Mrs. X had gotten up and walked 10' to the bathroom and back with a walker and a stand-by assist.
10 minutes later, All the labs came back normal.
Complete fluke with the labs?
The original lab was drawn in the AC area, in the same arm that the IV was infusing. The second lab draw was taken from the other arm where the IV wasn't infusing. I said, "Well, what probably happened was that the D5NS was simultaneously boosting the sugar and diluting the rest of the blood." None of my coworkers took my theory seriously. Even one of the "seasoned" nurses said, "no that's ridiculous, they probably got the vial mixed up with someone elses somewhere else in the hospital!!"
Now, I'm no chemistry/lab expert, but I don't think my theory is far off. I had an asymptomatic patient with an HGB of 6.5 one time and the physician suggested it was a diluted sample and a redraw (the physician was wrong in that case, but that's besides the point). I was just wondering if anyone has run into this type of thing before. Is it conceivable that dextrose would show up as glucose in a lab test? They're very similar chemically. Maybe someone with more chemistry experience can either back me up or refute my theory?
ps:No one was freaking out except the nurse that had the patient, we were all kind of "meh" after we realized the patient was completely asymptomatic.
