title: Masked hypoglycemia in the presence of icodextrin for peritoneal dialysis.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, N 46202, USA.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Khouli
mesh_terms: D000369:Aged, 80 and over; D015190:Blood Glucose Self-Monitoring / Q000295:instrumentation*; D003072:Cognition Disorders / Q000209:etiology; D015314:Dialysis Solutions / Q000009:adverse effects*; D004636:Emergency Service, Hospital; D005189:False Positive Reactions; D005936:Glucans / Q000009:adverse effects*; D005947:Glucose / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007003:Hypoglycemia / Q000175:diagnosis* / Q000628:therapy; D007022:Hypotension / Q000150:complications; D000077607:Icodextrin; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D010530:Peritoneal Dialysis; D013549:Sweetening Agents / Q000627:therapeutic use
chemical_list: D015314:Dialysis Solutions; D005936:Glucans; D013549:Sweetening Agents; D000077607:Icodextrin; D005947:Glucose