Severe unrecognised hypoglycaemia presenting as pseudonormoglycaemia and unexplained coma in two patients with renal failure.

We describe the occurrence of pseudonormoglycaemia and the consequences of severe prolonged hypoglycaemia observed in two patients with renal failure requiring renal replacement therapy. There was a persistent discrepancy, in both cases, between glucose levels measured by the hospital laboratory and those measured by the bedside glucometer, resulting in a significantly false high glucose measurement (pseudonormoglycaemia). This inaccurate glucose determination led to a delayed diagnosis of their truly severe and prolonged hypoglycaemia ultimately leading to prolonged coma and death. Icodextrin, a polysaccharide commonly used in continuous ambulatory peritoneal dialysis solutes, and maltose-containing solutions such as immunoglobulins for intravenous administration, can cause a dangerous overestimation of glucose levels determined by capillary blood glucose analysers utilising glucose dehydrogenase. A high level of awareness is required in order to avoid incidents related to misinterpretation of glucose levels.

Spontaneous pneumothorax in the third trimester of pregnancy.

The present report concerns a young woman previously diagnosed as having childhood asthma who presented with a secondary spontaneous pneumothorax during the third trimester of pregnancy; at term a caesarean section was recommended for safety reasons. Post partum a severe fixed ventilatory defect unresponsive to inhaled bronchodilator and a short oral course of steroids ruled out asthma. Diffuse bronchiectasis was found on her chest CT scan, although this was not evident clinically. Known aetiologies for diffuse bronchiectasis (cystic fibrosis, anti-α1 antitrypsin deficiency, rheumatic diseases, mycobacterial infections, childhood infections and immune deficiencies) were ruled out. Therefore it is believed her bronchiectasis was idiopathic or congenital. No recommendations from recent guidelines on how to manage labour in a woman after a spontaneous pneumothorax could be found. However, a literature search revealed that pregnant women usually experience primary pneumothorax and may continue in natural labour; however, it is unknown how best to manage a woman with secondary spontaneous pneumothorax.