Failure to determine the blood glucose level early in the evaluation can result in a delayed or missed diagnosis with associated morbidity due to CNS injury or unnecessary invasive procedures and therapies.13 Always consider hypoglycemia as a potential cause of altered mentation and rapidly screen for it at the bedside, followed by replacement therapy, regardless of the presumed reason for a patient's condition. The use of bedside testing is preferred in that the result is immediately available to the clinician and its result may alter therapeutic and diagnostic plans. 13 The accuracy of bedside reflectance tests is acceptable though less reliable at extremely low and high glucose levels.

If possible, immediately prior to intravenous (IV) dextrose therapy, a serum sample should be obtained and sent to the lab for confirmation. Glucose values of whole blood are approximately 15 percent less than serum or plasma. This discrepancy is due to the relatively low glucose concentration in red blood cells—with storage, equilibration occurs. Venous blood has a 10 percent lower glucose concentration when compared with either capillary or arterial blood. Finally, the collecting tube should contain fluoride to inhibit glycolysis in vitro before the sample is assayed.

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