When analyzing the ACLS guidelines for tPA administration with acute ischemic strokes it is essential to take a close look at the exclusion criteria for administration. In general the exclusion criteria refer to bleeding risks like PLT count, HTN, and recent surgery. However, one criteria has nothing to do with bleeding.
Blood Glucose <50 or >400
Why would patients with abnormal glucose levels meet the exclusion criteria for tPA administration?
Abnormal glucose levels will lead to neurological changes that can imitate neuro changes associated with acute ischemic stroke. Therefore when a patient has low or too high glucose levels it can be hard to identify for sure that the patient is actually having a stroke and therefore you cannot with certainty expose them to the risks associated with tPA.
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But, Doesn’t the CT Scan Confirm Stroke
Not necessarily. Ischemic stroke infarcts do not appear immediately on scans as the changes within infarcted tissue take time to reveal itself on the CT scans. This is not the case with hemorrhagic strokes obviously.
Signs of Ischemic Stroke
The signs of an ischemic stroke are listed below as stated by Beaumont. You will notice that they are incredibly similar to the signs associated with hypoglycemia.
- Sudden numbness or weakness of the face, arm or leg, especially involving one side of the body
- Sudden confusion, trouble speaking or understanding
- Loss of vision in one or both eyes
- Trouble walking, dizziness, loss of balance or coordination
- Sudden, severe headache with no known cause
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Conclusion
So, the reason that you do not give tPA to suspected stroke patients with low or high blood sugars has to do with simply assuring that the patient is not simply exhibiting symptoms of low blood sugars.
