Surestimation de la glycémie capillaire chez des patients diabétiques, insuffisants rénaux et traités par dialyse péritonéale : un piège à éviter

Two patients were admitted in the emergency department with a severe alteration of the consciousness. The glycemias measured with a glucometer of the type Accu-chek® were largely overvalued. Both patients were diabetic, with terminal renal insufficiency and were treated by peritoneal dialysis. Rapid control of the glycemia by laboratory test permitted a correct diagnosis of hypoglycemia, as the cause of the neurological deterioration and they went back to the normal after correction of the glycemia by correct glucose supply. These cases illustrate how a glucometer using the measurement of glucose deshydrogenase may overvalue the blood level of glucose. This comes from an interference in the measurement with the derivates of maltose, product of the metabolization of the icodextrine (Extraneal®), an osmotic component of the solution used for the peritoneal dialysis. Although some cases are already reported in the literature, it seems that the phenomenon is still unknown by many emergency physicians and it appeared important to emphasize the danger of this diagnostic trap. This is concerning the following devices: Freestyle Papillon Mini®, Freestyle Papillon Vision®, Freestyle Papillon Lite® from Abbott Diabetes® and Accu-chek GO®, Accu-chek Sensor®, Accu-chek Performa®, Accu-chek Active® from Roche Diagnostic®.