Hypoglycemia in nondiabetic patients undergoing albumin dialysis by molecular adsorbent recirculating system

Abstract

It was observed that patients developed episodes of hypoglycemia during molecular adsorbent recycling system (MARS) treatment. The aim of this study is to assess the effect of MARS treatment on blood glucose concentration to formulate appropriate dextrose replacement guidelines during MARS dialysis. Five patients with liver failure each underwent a 6- to 8-hour MARS treatment. No patient had a history of diabetes or was administered insulin or oral antihyperglycemic agents throughout the period of albumin dialysis. There was no active intervention or restriction on glucose intake. Rather, a dextrose drip and boluses were allowed based on each patient's condition and the clinical judgment of the attending physician. Blood glucose concentration was monitored hourly during the period of MARS treatment. Glucose loss in dialysate fluid was quantified hourly by measuring the total volume of dialysate fluid and assaying the glucose concentration in dialysate fluid. Mean glucose removal during a 6-hour MARS session was 37.19 ± 5.58 g. Mean glucose removal rate was 6.20 ± 0.93 g/h. In addition to a maintenance drip supporting the caloric requirement of patients, a dextrose replacement drip that paralleled the rate of glucose removal would prevent patients from experiencing episodes of hypoglycemia during MARS treatment. Dextrose replacement at a mean rate of 6 g/h (range, 5 to 7 g/h) in patients without diabetes undergoing albumin dialysis by MARS is recommended.