title: Severe unrecognised hypoglycaemia presenting as pseudonormoglycaemia and unexplained coma in two patients with renal failure.
abstract: We describe the occurrence of pseudonormoglycaemia and the consequences of severe prolonged hypoglycaemia observed in two patients with renal failure requiring renal replacement therapy. There was a persistent discrepancy, in both cases, between glucose levels measured by the hospital laboratory and those measured by the bedside glucometer, resulting in a significantly false high glucose measurement (pseudonormoglycaemia). This inaccurate glucose determination led to a delayed diagnosis of their truly severe and prolonged hypoglycaemia ultimately leading to prolonged coma and death. Icodextrin, a polysaccharide commonly used in continuous ambulatory peritoneal dialysis solutes, and maltose-containing solutions such as immunoglobulins for intravenous administration, can cause a dangerous overestimation of glucose levels determined by capillary blood glucose analysers utilising glucose dehydrogenase. A high level of awareness is required in order to avoid incidents related to misinterpretation of glucose levels.
authors.affiliation: Soroka University Medical Center, POB 151, Beer-Sheva, 84101, Israel.
authors.forename: Ori
authors.initials: O
authors.lastname: Galante
authors.forename: Avital
authors.initials: A
authors.lastname: Abriel
authors.forename: Lone S
authors.initials: LS
authors.lastname: Avnun
authors.forename: Boris
authors.initials: B
authors.lastname: Rugachov
authors.forename: Yaniv
authors.initials: Y
authors.lastname: Almog