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A 40-year-old woman was taken to a hospital emergency department (ED) suffering from gastrointestinal bleeding, nausea, and weakness. A nurse started an infusion of 5% dextrose in lactated Ringer's solution in the patient's right hand. Then she called the laboratory to send someone to draw samples for blood analysis.
A laboratory technician went to the ED, drew the blood, and returned to the laboratory to do the tests. Within minutes, she called the doctor to report a blood glucose level of 960 mg/dl.
The doctor immediately ordered the solution being infused changed to normal saline solution with 20 mEq of potassium chloride added; He also ordered a bolus of 10 units of regular insulin, followed by a second infusion containing regular insulin.
An hour later, the patient showed signs of hypoglycemia. Another blood sample was drawn; this time the glucose level was only 39 mg/dl. The doctor stopped the insulin infusion and gave 50% dextrose I.V. He also ordered the first infusion changed back to the original solution. Two hours later, the patient's glucose level was 90 mg/dl-within normal limits.
What happened? Simple-the laboratory technician had taken the first blood samples from a vein in the patient's right arm, the same arm being used for the dextrose infusion.
Don't let yourself be fooled by such an obvious mistake. Be suspicious when a blood glucose level is abnormally high, and confirm it before starting treatment.