Severe unrecognised hypoglycaemia presenting as pseudonormoglycaemia and unexplained coma in two patients with renal failure

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.