- 期刊
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Iatrogenic Hypoglycemia Due to Spurious Glucose Readings on Two Patients with Peritoneal Dialysis Using Icodextrin-Containing Dialysate
在使用含澱粉類多醣透析液的腹膜透析患者因錯誤血糖試紙數值發生的兩例醫源性低血糖
摘要
在本文中，我們報導兩位糖尿病併發慢性腎衰竭接受腹膜透析的病患，因使用愛多尼爾透析液，進而引發醫源性低血糖，其中一位病患甚至因此意識喪失。愛多尼爾為－含有icodextrin的透析液。Icodextrin在人體被吸收後會代謝成其他寡糖，如麥芽糖(maltose)等。此類寡糖可以和市面上運用GDH-PQQ原理的血糖機試紙產生交互作用而顯示較高卻不正確的血糖值。若病患依照此結果施行胰島素注射。便有可能導致醫源性低血糖。因此，糖尿病併發慢性腎衰竭接受腹膜透析的病患，若使用愛多尼爾透析液時，不應該使用GDH-PQQ原理的血糖機，以免產生醫源性低血糖。
並列摘要
We report herein upon two episodes of iatrogenic hypoglycemia, one of which even presented as hypoglycemic coma, developed by two independent diabetic patients with end-stage renal disease (ESRD) under peritoneal dialysis (PD). Both of these patients were using one exchange of icodexrtin containing dialysate and were apparently wrongly taking a normal-to-high glucose reading by means of a capillary glucose monitor (Accu-Chek, active, Roche Diagnostics, Mannheim, Germany). Absorbed icodextrin is hydrolysed in the systemic circulation to oligosaccharides such as maltose, maltotriose and maltotetraose. These metabolites can interfere with some capillary blood glucose-monitoring devices using glucose dehyrogenase pyrroloquinolinequinone (GDH-PQQ) method, and can cause a false, higher-glucose reading, thus hypoglycemia may therefore occurred when treatments were guided by these readings, Thus, glucose monitoring devices that use GDH-PQQ method can not be chosen for monitoring glycemic control in patients commencing PD with icodextrin-containing dialysate.