icodextrin and Hypoglycemia

Health care professionals (HCPs) depend upon "point-of-care" (POC) glucometers to provide appropriate treatment in emergency and hospital environments. Most devices located in these settings use nonspecific test strip methodology (NSTSM), which is unable to distinguish glucose from nonglucose sugars, including maltose. This flaw can result in erroneous administration of insulin and harm to patients. Icodextrin is a colloidal osmotic agent used in peritoneal dialysis (PD) solutions to augment ultrafiltration and waste removal. The main metabolite of icodextrin is maltose.. Three representative case reports of inappropriate medical action related to in-hospital use of NSTSM monitoring in PD patients using icodextrin are provided to emphasize importance of this interaction and HCP awareness.. PD patients using icodextrin before hospitalization exhibited marked discrepancy between blood glucose (BG) measurements obtained from POC-NSTSM glucometers and those obtained by glucose-specific methods in clinical chemistry laboratories leading to inappropriate administration of insulin by HCPs and symptomatic hypoglycemia in all patients. None of the patients received icodextrin during hospitalization.. Non-nephrology HCPs are unaware that POC glucometers are nonglucose specific and do not possess comprehensive knowledge of drug metabolism, particularly for uncommonly seen agents. The case reports highlight the absolute need for use of glucose-specific assays in BG determinations for patients using icodextrin within 2 weeks of hospitalization. To avoid future devastating consequences including severe hypoglycemia, coma, or death related to the drug-device interaction described, hospital protocols should require that all PD patients' BGs are measured in central chemistry laboratories.

Topics: Blood Glucose; Dialysis Solutions; Drug Interactions; Glucans; Glucose; Humans; Hypoglycemia; Hypoglycemic Agents; Iatrogenic Disease; Icodextrin; Insulin; Monitoring, Physiologic; Peritoneal Dialysis; Risk

Handheld glucose meters remain a rapid means of excluding hypoglycemia as a cause of altered mental status in the Emergency Department. However, emergency physicians must be alert for factors that can mask hypoglycemia at the bedside.. An 80-year-old man with diabetes mellitus and end-stage renal disease on peritoneal dialysis presents with altered mental status, hypotension, and a bedside handheld glucose meter reading of 99mg/dL. His mental status failed to improve with treatment of hypotension and the patient was intubated for airway protection. Laboratory-measured serum glucose was 29mg/dL. His mental status improved after glucose administration. It was subsequently determined that the patient used icodextrin (Extraneal(®), Baxter Healthcare Corporation, Deerfield, IL) as his peritoneal dialysate. This is partly absorbed into serum and hydrolyzed to oligosaccharides that are falsely detected as glucose by many handheld glucose meters.. The peritoneal dialysate icodextrin can produce falsely elevated bedside glucose meter values. As the prevalence of diabetic nephropathy and dialysis increases, emergency physicians must remain vigilant for such cases of unrecognized hypoglycemia.

Topics: Aged, 80 and over; Blood Glucose Self-Monitoring; Cognition Disorders; Dialysis Solutions; Emergency Service, Hospital; False Positive Reactions; Glucans; Glucose; Humans; Hypoglycemia; Hypotension; Icodextrin; Kidney Failure, Chronic; Male; Peritoneal Dialysis; Sweetening Agents

Topics: Diagnostic Errors; Dialysis Solutions; Equipment Design; Glucans; Glucose; Humans; Hypoglycemia; Iatrogenic Disease; Icodextrin; Monitoring, Physiologic; Peritoneal Dialysis

Topics: Blood Glucose; Blood Glucose Self-Monitoring; Brain Diseases, Metabolic; Coma; Diabetes Mellitus, Type 1; Diabetic Ketoacidosis; Diagnostic Errors; Dialysis Solutions; False Positive Reactions; Female; Glucans; Glucose; Glucose Dehydrogenases; Humans; Hypoglycemia; Icodextrin; Kidney Failure, Chronic; Maltose; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Product Labeling; Reagent Strips; Seizures; Substrate Specificity

Topics: Adult; Blood Glucose; Computers, Handheld; Coronary Artery Disease; Diabetes Mellitus; Diagnostic Errors; Dialysis Solutions; Glucans; Glucose; Humans; Hypoglycemia; Icodextrin; Kidney Failure, Chronic; Male; Peritoneal Dialysis; Reproducibility of Results

Topics: Dialysis Solutions; False Negative Reactions; Glucans; Glucose; Humans; Hypoglycemia; Icodextrin; Male; Peritoneal Dialysis, Continuous Ambulatory; Young Adult

Icodextrin, a peritoneal dialysate commonly used in the renal failure patient with diabetes, may lead to an overestimation of blood glucose levels as determined by bedside glucometers. This spurious hyperglycemia can lead to significant morbidity if unrecognized. We describe a case of severe hypoglycemia caused by an unappreciated overestimation of blood glucose in a diabetic patient with concomitant chronic renal failure requiring peritoneal dialysis with icodextrin.

Topics: Diabetes Mellitus, Type 2; Female; Glucans; Glucose; Humans; Hypoglycemia; Icodextrin; Middle Aged; Peritoneal Dialysis

A 45-year-old female diabetes-mellitus patient on peritoneal dialysis was admitted because of vertigo. During her stay in hospital she developed a comatose condition with abnormal head posture and deviation ofthe eyes to the left. Capillary blood from the fingertip showed a glucose value of 15.4 mmol/l. However, the automatically obtained glucose value delivered with a blood-gas analysis was found to be 1.2 mmol/l. The neurological state of the patient normalised fully after intravenous glucose administration. The glucose values were falsely elevated because the patient used a peritoneal dialysis fluid at night which contained icodextrin as an osmotic agent. Metabolites of icodextrin can influence blood-glucose measurements taken using analyzers that depend on the enzyme glucose dehydrogenase. To prevent potentially life-threatening situations, the use of an adequate glucose meter is of paramount importance.

Topics: Autoanalysis; Blood Glucose; Diabetes Mellitus, Type 1; Diabetic Coma; Female; Glucans; Glucose; Humans; Hypoglycemia; Icodextrin; Middle Aged; Peritoneal Dialysis; Peritoneal Dialysis, Continuous Ambulatory; Treatment Outcome

Topics: Blood Glucose; Diabetes Mellitus, Type 1; Glucans; Glucose; Humans; Hypoglycemia; Icodextrin; Peritoneal Dialysis, Continuous Ambulatory; Treatment Outcome

In a patient with diabetes mellitus undergoing icodextrin continuous ambulatory peritoneal dialysis, the interference caused by icodextrin metabolites in bedside glucose analyzers led to an overestimation of capillary glucose levels and the potential for inappropriate therapy. We report this case to raise an awareness of this among emergency care providers who are at the front-line treating diabetes emergencies.

Topics: Aged; Blood Glucose; Diabetes Mellitus, Type 2; Glucans; Glucose; Humans; Hypoglycemia; Icodextrin; Insulin; Kidney Failure, Chronic; Male; Peritoneal Dialysis

Topics: Blood Glucose; Capillaries; Coma; Diabetes Mellitus, Type 1; Dialysis Solutions; Female; Glucans; Glucose; Humans; Hypoglycemia; Icodextrin; Middle Aged; Peritoneal Dialysis