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Osmotic Minipump Implantation for Increasing Glucose Concentration in Mouse Cerebrospinal Fluid
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High Osmol Gap Hyponatremia Caused by Icodextrin: A Case Series Report
Caroline W H de Fijter1, Joanna Stachowska-Pietka2, Jacek Waniewski2
1Department of Internal Medicine/Nephrology, Amsterdam, The Netherlands.
American Journal of Nephrology
|August 14, 2023
Summary
Hyperosmolar hyponatremia can occur with standard icodextrin use in peritoneal dialysis (PD). This rare complication may stem from icodextrin degradation and metabolism issues, posing risks for PD patients.
Area of Science:
- Nephrology
- Biochemistry
Background:
- Icodextrin is used in peritoneal dialysis (PD) to manage fluid and solute balance.
- Hyperosmolar hyponatremia is a rare but serious complication associated with icodextrin use in PD.
Discussion:
- This report details three cases of hyperosmolar hyponatremia in PD patients using standard icodextrin prescriptions.
- The complication resolved upon discontinuation and recurred upon rechallenge, confirming icodextrin as the cause.
- Potential mechanisms involve exaggerated icodextrin degradation by alpha-amylase and/or rapid hydrolysis of degradation products, overwhelming intracellular metabolism.
Key Insights:
- Hyperosmolar hyponatremia can occur even with on-label icodextrin use in PD.
- Patient-specific factors influencing icodextrin metabolism may predispose individuals to this adverse effect.
- Both hyponatremia and hyperosmolality are significant risk factors for adverse outcomes in PD patients.
Outlook:
- Further research is needed to identify susceptible patient populations and refine icodextrin prescribing guidelines.
- Awareness among clinicians is crucial for early recognition and management of this rare complication.
- Investigating the role of alpha-amylase activity and oligosaccharide metabolism in PD patients is warranted.
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