社團法人臺灣臨床藥學會

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【案例報告】愛多尼爾腹膜透析液發生偽性高血糖的案例報告
The possibility of falsely high blood glucose reading caused by Extraneal® peritoneal dialysis solution— a case report
葡萄糖去氫酶、偽性高血糖、腹膜透析液、glucose dehydrogenase pyroloquinolinequinone (GDH-PQQ), falsely elevated blood glucose reading, peritoneal dialysis solution
鄭智仁Chin-Jen Cheng* 、陳家豪Chia-Hao Chen 、何志豪Chi-Hou Ho 、陳麗芳Agnes L.F.Chan
1財團法人奇美醫院 藥劑部
愛多尼爾腹膜透析液(Extraneal®)在臨床上主要用於移除病患體內多餘水份及毒素。因其為聚合體,分子體積大,無法直接由擴散作用進入腹膜內微血管,但仍有研究證實愛多尼爾腹膜透析液因含icodextrin,約34%~40%進入體內,驗血糖時與含葡萄糖去氫酶 (glucose dehydrogenase pyrroloquinolinequinone,GDH-PQQ)試紙發生反應而干擾血糖的檢測值進而造成誤判。因此,如使用含葡萄糖去氫酶的試紙來檢測血糖,即會干擾血糖值。本案例即為探討使用葡萄糖去氫酶測定法而造成血糖判讀異常。
62歲的腹膜透析病人,入院時精神狀況不佳且血糖偏低,病患經診斷為肺炎,且懷疑有腦部感染收住加護病房治療。病患有高血壓、糖尿病、不穩定型心絞痛、冠狀動脈疾病、週邊動脈阻塞性疾病(peripheral arterial occlusive disease, PAOD)、多處小腦梗塞病史及末期腎臟疾病(end stage renal disease, ESRD),繼續以愛多尼爾腹膜透析液進行腹膜透析。治療期間,因使用血糖機測出高血糖值335 mg/dl,所以用regular insulin 75unit/day以降低病患的血糖;因胰島素每天的使用量增加,血糖機測出的血糖值卻無明顯降低,於是醫療團隊追蹤病人病情及用藥,發現血糖機測出之高血糖可能為腹膜透析液所致之血糖誤判。故改以血液樣本送檢驗室以hexokinase的血糖測定法來檢測,發現病患血糖值已下降到20mg/dl,病患疑似昏迷。
對高血糖之洗腎病患,如使用愛多尼爾腹膜透析液時,應選擇glucose oxidase或hexokinase的血糖測定法,以免因其成分與含葡萄糖去氫酶血糖測試劑之藥物交互作用而造成偽陽性高血糖的判讀情況,影響病患的用藥安全。
 
Extraneal® peritoneal dialysis solution is indicated to draw extra fluid and toxins from bloodstream into peritoneal cavity. The fluid and toxins are removed from the body when the Extraneal® solution is drained out. Icodextrin is a large molecular weight and water-soluble glucose polymer. It is metabolized in the systemic circulation into different glucose polymers, but mainly maltose. Approximately 34%~40% of icodextrin have been shown to interfere with glucose tests using the glucose dehydrogenase prroloquinolinequinone-based method (GDH-PQQ) and therefore resulted in overestimation of blood glucose levels. This is to report a case received Extraneal® solution for peritoneal dialysis and presented falsely elevated blood glucose level by using GDH-PQQ method.
A 62-year-old peritoneal dialysis patient, who was in poor condition with hypoglycemia, was admitted to the intensive care unit (ICU) with the diagnosis of pneumonia and brain infection. Patient has a history of hypertension, diabetes, unstable angina, coronary artery disease, peripheral arterial occlusive disease, multiple small infarction and end stage renal disease. He was still receiving Extraneal® (icodextrin) peritoneal dialysis solution for renal failure. During the period of treatment, his blood glucose was monitored four times a day by using dehydrogenase pyrroloquinolinequinone-based (GDH-PQQ) glucometers, which showed that the blood glucose level was 335mg/dl. Therefore, a regular insulin with dose of 75unit daily was used to control the blood glucose level. Although the dose of insulin was given daily and increased everyday, the GDH-PQQ glucometers still showed high blood glucose value. The medical team traces the patient’s condition and medications. They found that the possibility of high blood glucose is likely to be caused by the Extraneal® solution. Therefore, they ordered laboratory-based blood glucose assays to compare the data measured by the GDH-PQQ glucometers. The result showed that the blood glucose level of the patient was 20mg/dl and the patient appeared hypoglycemia coma. This result confirmed that the blood glucose level reported by GDH-PQQ method may be interfered with the icodextrin contained in Extraneal® peritoneal dialysis solution. This case report would remind the clinicians that the glucometers based on the GDH-PQQ method should preferably not be used in patients who are receiving Extraneal® peritoneal dialysis to avoid a falsely elevated blood glucose level and protect patient’s safety.
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