Icodextrin을 이용한 지속성 외래 복막 투석중인 당뇨병 환자에서 혈당과다 측정으로 진단이 늦어진 저혈당성 혼수 1예

A case of Hypoglycemic Coma in a Diabetic Patient on Continuous Ambulatory Peritoneal Dialysis Using Icodextrin due to Overestimation of Blood Glucose

Diabetes has become more common, and is the most common cause of end-stage renal disease. Peritoneal dialysis is preferred therapeutic option for end-stage renal disease. Icodextrin is widespread use in peritoneal dialysis in patients with low ultrafiltration and high peritoneal transport properties. During dialysis 25% of the instilled icodextrin is absorbed into the blood stream via lymphatic system. Circulating icodextrin is hydrolysed by a-amylase to oligosaccharides such as maltose, maltotriose, maltotetrose. Oligosaccharides interferes with glucose assays that glucose dehydrogenase with coenzyme pyrroloquinolinequinone (GDH-PQQ), and fasely increased readings occur. A 56-years-old man with CAPD has admitted for further evaluation of extremities edema. He dialyzed four times a day and controled blood sugar via insulin. On Hospital day 10 (HD 10)，both lower extremities pitting edema aggrevated due to low ultrafiltration, and started 7.5% icodextrin solution. HD 29，As catheter tip malposition was observed on KUB, so we recommend him to descend the stairs for some time. HD 32， Suddenly patient complain of a dizzness, cold sweat, and comatose mentation. Finger stick glucose testing was 109mg/dL, but plasma glucose was 43mg/dL. We report a case of hypoglycemic coma in a diabetic patient on peritoneal dialysis with icodextrin due to overestimation of blood glucose with literature investigation.