Glucose and CRRT

 Q: Glucose free solution should be used in diabetic patients who require continuous renal replacement therapy (CRRT)?

A) True

B) False

Answer: B

Although the standard glucose-free solution is available for use in CRRT, it is preferable to continue to use a solution with a concentration of 100 mg/dL of glucose even in diabetic patients. It may be attractive to use glucose-free solution to have better control of hyperglycemia but the risk of possible hypoglycemia with a glucose-free solution in CRRT can be immediately life-threatening. Also, there are case reports of ketoacidosis in patients who underwent CRRT with glucose-free solutions.  

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References:

1. Ting S, Chua HR, Cove ME. Euglycemic Ketosis During Continuous Kidney Replacement Therapy With Glucose-Free Solution: A Report of 8 Cases. Am J Kidney Dis. 2020 Dec 3:S0272-6386(20)31140-9. doi: 10.1053/j.ajkd.2020.10.014. Epub ahead of print. PMID: 33278477.

2. Parikh R, Khanin Y, Wanchoo R, Barnett R, Sharma P. CRRT-associated ketoacidosis: A series of 5 cases. Clin Nephrol. 2021 Jun 18. doi: 10.5414/CN110460. Epub ahead of print. PMID: 34142948.