Patients with or without diabetes mellitus, chronic kidney disease (who may or may not be on maintanence hemodiallysis) often present with altered sensorium, seizures. Their serum glucose levels are within normal limits, but lumbar puncture reveals either low CSF glucose levels (
There are many reasons of chronic renal disease leading to hypoglycemia, such as:
Patients undergoing hemodialysis who are diabetic May often be told not to eat on dialysis therapy as the blood shots to the stomach to absorb the glucose from the food digested. In fact the mechanism in the dialyzer means that blue Coast being a low molecular weight molecule it will be removed during the dialysis therapy and what is normal for you and me I may not be normal range for that patient. Many patients report being very hungry coming off the dialysis therapy and may also experience low-blood-sugar and counters during the therapy.
Hypoglycorrhachia is usually not associated with chronic renal failure but a sign of meningeal infections:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4065645/
https://www.ncbi.nlm.nih.gov/pubmed/26299186
Patients are being dialysed usually with a dialysis bath of 5,8mmol/L resembling a fasting glucose serum level. If they do not eat on dialysis (it is not mandatory not to do so though the remarks of Dawn are right in principle ) they might come out with a serum hypoglycemia indeed. However, this does not necessarily explain a depressed CSF:serum ratio.
I´ve seen hypoglycemia in hemodialysis patients only in diabetic patients with insulin or oral antidiabetic drugs. To avoid the risk of hypoglycemia (1) glucose is routinely added to the dialysis bath and (2) a light meal is given during dialysis. It is unusual and unacceptable to the patients that they should not eat at dialysis. In patients at risk for hypoglycemia glucose levels should be checked during dialysis and food not be deprived during treatment. Thus, hypoglycemia can be avoided at dialysis treatment.
My dialysis patient develop hypoglycaemia if they are diabetic or elderly,we had introduce running dextrose 10% all over the session because they refuse food some times.
If a patient refuses to eat during dialysis, one should first look for other reasons of anorexia or loss of appetite, e.g. hypovolemia, and explain him the importance of good oral nutrition. Infusing of dextrose 10% during the session by the venous line may irritate the intima of dialysis access and prolonged use of intradialytic parenteral nutrition may lead to increased risk of infections, abnormalities in lipid profile, and accumulation of fat tissue rather than muscle (Rocco MV, Ikizler TA. Nutrition in Daugirdas JT (ed.). Handbook of Dialysis 5th ed. Wolters Kluwer 2015, 550)
So these patients have had good appetite, not fasting and have well controlled diabetes with medications.
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