Abstract #1412446: Pseudohypoglycemia in a Patient with Scleroderma with Minimal Skin Involvement

Point-of-care (POC) glucose monitor is often used in hospitalized patients and a valuable tool for deciding therapy cases of abnormal levels. However, it has limitations conditions such as Raynaud’s phenomenon, monoclonal gammopathies, leukemia, peripheral hypoperfusion. (1). Here, we describe patient whose results POC were unreliable, resulting overtreatment hypoglycemia. A 76-year-old African American woman with history scleroderma, diagnosed after skin biopsy was admitted Her symptoms scleroderma include significant esophageal dysmotility but minimal involvement. She initially treated hydroxychloroquine which improved her discontinued few months when suspected causing While rehab pubic rami fracture, she recurrent hypoglycemia started on Diazoxide. transferred to our facility because persistent requiring dextrose drip multiple infusions 25g 50 percent glucose. Despite being Diazoxide, had remained hypoglycemic blood readings low 30-50 mg/dl. 72-hour fast initiated, Diazoxide stopped. fasting sugar test off four days showed discordant fingerstick plasma levels 59 mg/dl 138 mg/dl, respectively. Plasma insulin (<1 uU/ml), proinsulin (1.6 pmol/L), C-peptide (0.4 ng/ml) appropriately the setting fast. Records from inpatient three episodes measured by POC. all values seen testing corresponding normal level. We could not find an episode confirmed test. checked several times, none them elevated Insulin ranged 2.2-13.0 [2.6-24.9 uU/ml], 1.2-2.0 [1.1-4.4 ng/ml], within limits. Additional workup other etiologies cortisol stimulation test, IGF-2, chromogranin A. This based only. If been confirm this have pseudohypoglycemia sooner avoided unnecessary medications. also dextrose-containing intravenous fluids Treating reflexively understandable, given risks withholding treatment. likely contributed patient’s nausea anorexia already caused dysmotility. It that involvement disease minimized suspicion psudohypoglycemia. worth mentioning hydroxychloroquine, management, stopped presumed case highlights importance confirming evaluating potential causes results.