Hipoglicemia artefatual em paciente com esclerose sistêmica e Fenômeno de Raynaud

Abstract

The artifactual hypoglycemia can be defined as a discrepancy between capillary and plasma glucose levels due to different laboratory techniques or other factors of the patient. In patients with Systemic Sclerosis (ES) and / or Raynaud (FR) phenomena, it is necessary to suspect and identify them early. In the study will be presented a man diagnosed with diffuse ES for 4 months, who needed urgent care. He had some symptoms of pancreatitis, which was discarded the next day and required urgent hemodialysis. He then had recurrent episodes of malaise and sweating during hemodialysis sessions, which were associated with capillary hypoglycemia. After initiation of the dialysis treatment, gastric symptoms improved, with persistence of repeated episodes of low blood glucose. Serum glycoside was started in continuous infusion, suggesting as a possible diagnosis Addison's Syndrome, which was refuted after investigation. In the case in question, episodes of low blood glucose were due to RF (present in the majority of ES patients), attributed to anxiety, cold room temperature and dialysate bath. The low levels of glucose in this patient were due to ischemia, with reduction of capillary flow and consequent increase in its extraction. After performing alternative measures of simultaneous blood glucose, the results were divergent. This case demonstrates the importance of high suspicion of artifactual hypoglycemia in recurrent hypoglycemia without improvement with conventional therapy, especially in ES and / or RF patients. It is important to recognize and understand this condition to avoid unnecessary investigations and excessive treatment.