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Monitor: 10

10 - A Case of Pseudo Hypoglycemia in a Patient with Leukocytosis

Friday, Apr 26
11:00 AM – 11:30 AM

Objective : Hypoglycemia is most convincingly documented by Whipple’s triad: symptoms of hypoglycemia, low plasma glucose and relief of symptoms after treatment. Pseudo hypoglycemia is a condition which is associated with an artifactually low glucose concentration in the absence of classic signs and symptoms. We present a case of pseudo hypoglycemia where leukocytosis played a role in lowering venous glucose.


Methods :

A 65-year-old male with a history of gout was admitted for evaluation of hematuria. Labs during his admission revealed a venous blood glucose of 43mg/dl. Point of care glucose checks were not ordered on admission as the patient was not diabetic. The patient no hypoglycemia symptoms and received no anti hyperglycemic medications. He had an HbA1c of 6.2%. He was hemodynamically stable with no signs of infection. The only other lab abnormality noted was a leukocytosis of 95 thousand/µL. Point of care glucose checks were ordered with meals and at bedtime.  Subsequent venous blood glucose next day was reported as 27 mg/dL, patient remained asymptomatic and his corresponding point of care glucose was 92 mg/dL. A close evaluation of the case revealed delay in the venous sample analysis. Immediate processing of sample revealed a normal glucose (90mg/dL) that correlated with the simultaneous point of care glucose. Repeat testing with quick processing of the sample clarified that low venous blood glucose level was due to in vitro glucose consumption by leukocytes between the time of the blood draw and sample analysis


Results : NA


Discussion :

Pseudo hypoglycemia is not a clinical syndrome rather a result of artifactually low glucose concentration. Although there are case reports in the literature, the phenomenon is under-recognized. Causes of pseudo hypoglycemia differ based on the method of glucose measurement. Low capillary blood glucose is seen in situations with decreased perfusion, such as in patients with peripheral vasoconstriction in hypovolemic shock, Raynaud’s disorder. Decreased perfusion leads to increased glucose uptake by peripheral tissues. In contrast, low venous blood glucose levels can be observed in leukemia or polycythemia vera where high nucleated cell counts cause increased glycolysis. Waldenstrom macroglobulinemia has also been reported to generate falsely low venous blood glucose readings due to interference of the proteins with the lab test. Pseudo hypoglycemia should be considered in asymptomatic patients with low blood glucose levels before initiating an extensive work up.


Conclusion : Pseudo hypoglycemia should be considered in asymptomatic patients with low venous blood glucose values, which do not correlate with point of care glucose values. 

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Michael A. Weintraub

Internal Medicine Resident
Thomas Jefferson University Hospital
Philadelphia, Pennsylvania

Michael Weintraub is an Internal Medicine Resident at Thomas Jefferson University. He graduated from the University of Pennsylvania with an undergraduate degree in Biology and Healthcare Management from the Wharton School. He worked for two years as a management consult at ClearView Healthcare Partners after which he attended medical school at Rutgers Robert Wood Johnson University.

Deepika Nandiraju

Fellow in training
Thomas Jefferson University hospital
Philadelphia, Pennsylvania

second year Fellow in training

Monika Shirodkar

Associate Professor of Clinical Medicine
Thomas Jefferson University Hospital
Philadelphia, Pennsylvania

Associate Professor of Clinical Medicine amd Program Director of the Endocrine Fellowship program at Thomas Jefferson University Hospital, Philadelphia PA.

Michael A. Weintraub

Internal Medicine Resident
Thomas Jefferson University Hospital
Philadelphia, Pennsylvania

Michael Weintraub is an Internal Medicine Resident at Thomas Jefferson University. He graduated from the University of Pennsylvania with an undergraduate degree in Biology and Healthcare Management from the Wharton School. He worked for two years as a management consult at ClearView Healthcare Partners after which he attended medical school at Rutgers Robert Wood Johnson University.