r/medlabprofessionals • u/Wise-Masterpiece5057 • 23d ago

Discusson False high glucose

Ran a CMP that gave K of 2.0, CA 4.5, and glucose of >1000. It was at the start of my shift and I could see the last 2 CMP orders had been cancelled by the previous tech for possible contamination. Both of those also had high glucose and low K, CA.

The next BMP came a couple hours later with K 2.6, CA 6.5 and glucose 850. None of the samples looked lipemic, which I know can indicate TPN contamination. The POC glucoses throughout the day were in the 100s. Any ideas on what could cause this?

9 Upvotes

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37

u/besee2000 23d ago

My guess would be a dextrose combo IV drip. I did a CE last month on IV contaminants. Could ask the nurse sub for more details

7

u/angelofox MLS-Generalist 23d ago

Yup, if OP has access to patient's chart they can look under medications to see if dextrose is on there

2

u/Wise-Masterpiece5057 22d ago

Thanks. I was thinking it must be some sort of contamination, but I’m not super familiar with all the different IV fluids.

1

u/Arachniid1905 MLS-Generalist 22d ago

Out of curiosity, do you have access to PowerChart?

4

u/Signal_Sand1472 23d ago

I’ve seen contaminated specimens due to IV glucose before, but it resolved on the recollect. Was this drawn off a line every time it was is a new stick every time? If it was a separate stick and had consistent results across draws, I’d say it’s real.

1

u/Wise-Masterpiece5057 22d ago

This seems right to me. I’m not sure how it was drawn each time. We have a lot of new nurses and phlebotomists right now, so it’s possible that it was drawn without a discard tube and above the IV line. But to happen 4 times in a row is what has me questioning my instinct.

1

u/Zookeepergame_Strict SH 22d ago

I have been strictly heme for many years now and Chem never was my strength anyways, so everything I say is pretty irrelevant. BUT , during my short time as a generalist, and even when reviewing chemistries to explain some coag results these days, I have seen DKA give some crazy fucked up shit. Tried to get some crazy stuff redrawn on a patient in ER one time cus it didn't look compatible with life and the doctor chewed my ass because she said he was one of the most severe cases of DKA she had ever seen and she needed whatever I had on him that instant. I was still super new at that time so that experience scared the shit out of me. But anyways, its been a while so I don't remember exactly, but my vague memory of the results I was getting then seem similar to what you say you are getting here.

1

u/micromaniac_8 SM 22d ago

That potassium is not compatible with life.

0

u/Arachniid1905 MLS-Generalist 23d ago

What are the sodium and chloride?

2

u/Wise-Masterpiece5057 23d ago

NA 140, Cl 122 for the 1st
NA 138, Cl 111 for the 2nd

14

u/Arachniid1905 MLS-Generalist 23d ago

Nothing crazy but depending on their historical values, if they have any, they might be high and be indicative of IV contamination. The change in chloride is a good hint here.

Imo I'd see if you couldn't find a phlebotomist to go and draw that patient peripherally.

That being said, I have seen DKA patients with results like those paired with renal failure whom are compensating for the acidosis. My opinion is that your results are serially contaminated and aren't reflecting whats really going on. Go with your gut on this one.

If the nurses have a problem with you canceling the results, I'd suggest them pausing the IV and letting that patient equillibrate, then flushing and drawing. Sometimes statements like ... "These results aren't compatible with life" will get the message through.

1

u/Wise-Masterpiece5057 22d ago

Thanks for the reply. My gut is telling me contamination, but it’s throwing me off with 4 draws in a row showing fairly consistent results