title: Recalcitrant hypoglycemia resolved with 2.5% dextrose containing replacement fluid during hemodiafiltration.
abstract: A 52-year-old African American male was admitted with acute kidney injury (AKI) four days after renal cryotherapy. He was started on continuous veno-venous hemodiafiltration (CVVHDF) immediately but his subsequent course was complicated by recurrent hypoglycemia, poorly responding to conventional therapy. To address the recalcitrant hypoglycemia, we changed the replacement fluid to 5% dextrose in water with 150 mEq/L of sodium bicarbonate, Y-connected with 0.9% sodium chloride at a global rate of 2000 mL/hr, with resolution of refractory hypoglycemia. A modified CVVHDF employing hyperglycemic solution can be a valuable addition in treatment of AKI complicated by severe refractory hypoglycemia.
authors.affiliation: Department of Internal Medicine, Division of Nephrology, University of Mississippi Health Care and University of Mississippi Medical Center, Jackson, MS 39216, USA. tfulop@umc.edu
authors.forename: Tibor
authors.initials: T
authors.lastname: Fülöp
authors.forename: Benahili U
authors.initials: BU
authors.lastname: Iboaya
authors.forename: Ramachandram
authors.initials: R
authors.lastname: Avusula
authors.forename: Eva
authors.initials: E
authors.lastname: Csongrádi
authors.forename: Luis A
authors.initials: LA
authors.lastname: Juncos
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D003452:Cryosurgery / Q000009:adverse effects* / Q000379:methods; D005947:Glucose / Q000008:administration & dosage*; D017583:Hemodiafiltration / Q000009:adverse effects / Q000379:methods; D015312:Hemodialysis Solutions / Q000008:administration & dosage / Q000009:adverse effects / Q000737:chemistry; D006801:Humans; D007003:Hypoglycemia / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D007680:Kidney Neoplasms / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D018805:Sepsis / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D015312:Hemodialysis Solutions; D005947:Glucose