Point-of-care glucose, ketone and urinalysis testing

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Target exams

Red flags

• Acting on a single capillary glucose meter reading in a neonate because the high haematocrit, the low oxygen, and the galactose or maltose interference with the glucose dehydrogenase strips can give a falsely low or falsely high value; confirm any critical or unexpected value with a laboratory plasma glucose
• Reassuring a family that the urine ketones are improving when the acetoacetate pad stays high or even rises during the recovery from the diabetic ketoacidosis, because the beta-hydroxybutyrate converts to the acetoacetate as the ketosis resolves and the urine test lags behind the true metabolic state
• Excluding a urinary tract infection from a negative nitrite in a young infant, because the frequent voiding gives no bladder dwell time for the nitrate conversion and the nitrite sensitivity falls to approximately fifty percent even though the specificity stays high
• Diagnosing a urinary tract infection from a dipstick alone, because the leukocyte esterase and the nitrite are a screen and the febrile non-toilet-trained child needs the culture from a low-contamination specimen before any antibiotic
• Missing the euglycaemic diabetic ketoacidosis because the glucose is under eleven millimoles per litre, which occurs in the young or partially treated child; the ketone and the blood gas make the diagnosis, not the glucose alone

Life stages

Care settings

Clinical exam formats

Board mappings

• States that the capillary blood glucose meter measures the whole-blood glucose by the glucose oxidase or the glucose dehydrogenase reaction and that a critical or unexpected reading in a neonate must be confirmed by a laboratory plasma glucose because the high haematocrit and the galactose or maltose interference can bias the result
• Recognises that the blood beta-hydroxybutyrate ketone meter is the preferred measure over the urine acetoacetate in the diabetic ketoacidosis because the beta-hydroxybutyrate is the predominant ketone and tracks the resolution, while the urine ketones can lag or paradoxically rise during the recovery
• Describes the urine dipstick pads of the leukocyte esterase and the nitrite as a screen for the urinary tract infection that does not replace the culture, and the lower sensitivity of the nitrite in the young infant from the frequent voiding
• Applies the ISPAD 2022 diabetic ketoacidosis definition of the blood beta-hydroxybutyrate greater than three millimoles per litre with the venous pH under 7.3 and the bicarbonate under fifteen, and the glucose greater than eleven millimoles per litre
• Interprets the combined leukocyte esterase and nitrite result with the high negative predictive value of the both-negative dipstick and the need for the culture from the catheterisation or the suprapubic aspiration in the febrile non-toilet-trained child
• Anticipates the point-of-care glucose meter errors in the neonate from the haematocrit, the oxygen, and the galactose or maltose interference and selects a meter with the interference correction
• The blood beta-hydroxybutyrate thresholds of the less than 0.6 millimoles per litre as the normal, the 0.6 to 1.5 as the mild ketosis, and the greater than 3.0 as the level associated with the diabetic ketoacidosis
• The dipstick performance with the leukocyte esterase sensitivity of approximately 67 to 94 percent, the nitrite sensitivity of approximately 50 percent and the specificity of approximately 98 percent, and the lower nitrite reliability in the young infant
• The glucose meter interference in the neonate and the rule to confirm the critical value with the laboratory plasma glucose
• Performs and interprets the capillary blood glucose, the blood beta-hydroxybutyrate ketone, and the urine dipstick at the bedside with the correct specimen handling and the quality control
• Communicates the result, the limitations, and the next step to the family in the language they understand, and frames the dipstick as a screen pending the culture
• Recognises and manages the falsely reassuring results including the lagging urine ketones, the negative nitrite in the infant, and the meter error in the neonate
• Level 1: Performs the capillary blood glucose, the blood ketone, and the urine dipstick with the correct technique and the safety checks
• Level 2: Interprets the three point-of-care tests in the clinical context, recognises the meter and the dipstick limitations, and confirms the critical glucose with the laboratory plasma glucose
• Level 3: Leads the point-of-care testing quality programme, the staff training, and the protocol for the confirmation of the critical values
• The three point-of-care tests, the specimen, the chemistry, and the clinical use of each
• The blood beta-hydroxybutyrate thresholds and the reason it is preferred over the urine acetoacetate in the diabetic ketoacidosis
• The leukocyte esterase and the nitrite performance and the lower nitrite sensitivity in the young infant
• Demonstration of the bedside capillary glucose and the blood ketone measurement with the correct technique and the safety checks in a structured oral or the objective structured clinical examination
• Interpretation of the urine dipstick in the febrile child and the communication of the screen-versus-culture principle to the examiner
• Discussion of the falsely reassuring results and the confirmation of the critical values
• The American Academy of Pediatrics urinary tract infection guideline principle that the dipstick is a screen and the culture from the catheterisation or the suprapubic aspiration confirms the infection in the febrile non-toilet-trained child
• The beta-hydroxybutyrate over the urine ketone in the diabetic ketoacidosis and the ISPAD diagnostic thresholds
• The glucose meter interference in the neonate and the confirmation of the critical value with the laboratory plasma glucose
• Performs and interprets the capillary glucose, the blood ketone, and the urine dipstick at the bedside as a core procedural competency
• Recognises and counsels on the meter and the dipstick limitations and the falsely reassuring results
• Leads the point-of-care testing quality programme and the confirmation of the critical values
• The Canadian approach to the bedside glucose, ketone, and urinalysis with the confirmation of the critical glucose and the culture-based diagnosis of the urinary tract infection
• The blood beta-hydroxybutyrate over the urine ketone in the diabetic ketoacidosis and the ISPAD thresholds
• The glucose meter interference and the quality programme for the point-of-care testing in the paediatric intensive care unit