A Comparison of Insulin Doses for the Treatment of Hyperkalemia in Patients with Renal Insufficiency

LaRue, Heather; Peksa, Gary D.; Shah, Shital

doi:10.1002/phar.2038

Cited by 41 publications

(50 citation statements)

References 24 publications

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“…The recorded incidence of hypoglycaemia (22%), severe hypoglycaemia (6%) and the median time to detection of hypoglycaemia (108 min) in our study is consistent with previous reports 5 9–13 15–18. The increased prevalence of hypoglycaemia in our sample compared with other cohorts may reflect the exclusion of patients receiving therapies such as dextrose containing intravenous solutions and albuterol that are expected to be protective against the development of hypoglycaemia and were not adequately controlled in previous samples.…”

Section: Discussionsupporting

confidence: 89%

“…Changes in blood glucose remain difficult to predict in patients treated with intravenous insulin and dextrose as no strategy has been conclusively demonstrated to mitigate the risk of subsequent hypoglycaemia. Reduced insulin and/or increased dextrose doses may be associated with a lower incidence of hypoglycaemia while maintaining the potassium-lowering effect but this is not consistent across all studies and hypoglycaemia was still observed in 6.1% to 19.5% of patients 10 12 17 19. Frequent monitoring of blood glucose is an important but underused step toward avoiding the sequelae of hypoglycaemia.…”

Section: Discussionmentioning

confidence: 99%

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Blood glucose reduction in patients treated with insulin and dextrose for hyperkalaemia

et al. 2019

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BackgroundDextrose is commonly administered with insulin during the management of hyperkalaemia to avoid hypoglycaemia. Previous research has evaluated the incidence of hypoglycaemia; however, none have reported the extent of blood glucose reduction after this regimen. The aim of this study was to better characterise the changes in blood glucose and to identify patients who may have an increased response to insulin.MethodsThis was a multicentre retrospective study evaluating adult patients who received a regimen of 10 units of intravenous regular insulin plus 25 g of intravenous dextrose to manage hyperkalaemia between January 2014 and September 2016. The primary outcome was to evaluate the extent of blood glucose reduction (milligram per decilitre) up to 6 hours following the above regimen. Secondary outcomes included incidence of hypoglycaemia (blood glucose <70 mg/dL) and severe hypoglycaemia (blood glucose <40 mg/dL), and predictors of the extent of blood glucose reduction.ResultsA total of 90 patients were included. The median blood glucose change over 6 hours was −24 mg/dL (IQR −53 to 6 mg/dL). Hypoglycaemia developed in 20 patients (22.2%, 95% CI 14.1% to 32.2%) and five patients (5.6%, 95% CI 1.8% to 12.5%) had severe hypoglycaemia. Patients who developed hypoglycaemia had a median baseline blood glucose of 110 mg/dL (IQR 80 to 127 mg/dL), which decreased to a median value of 52 mg/dL (IQR 40 to 60 mg/dL). Higher baseline blood glucose was significantly associated with greater blood glucose reduction (coefficient −0.36, 95% CI −0.55 to −0.18, p<0.001).ConclusionsThe extent of blood glucose reduction is variable and hypoglycaemia is common. The high incidence of hypoglycaemia highlights the importance of frequent blood glucose monitoring.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Blood glucose reduction in patients treated with insulin and dextrose for hyperkalaemia

et al. 2019

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“…These results are consistent with studies suggesting that preinsulin blood glucose levels less than 140 mg/dL and the standard 10 units of insulin for hyperkalemia treatment may increase the risk of hypoglycemia. 4,7,9 To decrease the risk of iatrogenic hypoglycemia, we redesigned our hyperkalemia insulin orderset to address the strongest predictors of hypoglycemia (doses of regular insulin greater than 0.14 units/kg and preinsulin blood glucose less than 140 mg/dL). The main changes were weight-based insulin dosing (based on previously published data) 10 and adjustment of glu-cose administration based on the patient's glucose levels.…”

Section: Discussionmentioning

confidence: 99%

Decreasing Hypoglycemia following Insulin Administration for Inpatient Hyperkalemia

Black

Lupa

Lemley

et al. 2020

Journal of Hospital Medicine

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H yperkalemia (serum potassium ≥5.1 mEq/L), if left untreated, may result in cardiac arrhythmias, severe muscle weakness, or paralysis. 1,2 Insulin administration can rapidly correct hyperkalemia by shifting serum potassium intracellularly. 3 Treatment of hyperkalemia with insulin may lead to hypoglycemia, which, when severe, can cause confusion, seizures, loss of consciousness, and death. The use of regular and short-acting insulins to correct hyperkalemia quickly in hospitalized patients results in the greatest risk of hypoglycemia within three hours of treatment. 4 Nonetheless, monitoring blood glucose levels within six hours of postinsulin administration is not a standard part of hyperkalemia treatment guidelines, 3 leaving the rates of hypoglycemia in this setting poorly characterized.Without standardized blood glucose measurement protocols, retrospective studies have reported posttreatment hypoglycemia rates of 8.7%-17.5% among all patients with hyperkalemia, 5,6 and 13% among patients with end-stage renal disease. 4 These estimates likely underestimate the true hypoglycemia rates as they measure blood glucose sporadically and are often outside the three-hour window of highest risk after insulin administration.At the University of California, San Francisco Medical Center (UCSFMC), we faced similar issues in measuring the true hypoglycemia rates associated with hyperkalemia treatment. In December 2015, a 12-month retrospective review revealed a 12% hypoglycemia rate among patients treated with insulin for hyperkalemia. This review was limited by the inclusion of only patients treated for hyperkalemia using the standard orderset supplied with the electronic health record system (EHR;

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“…Other rapid interventions that can assist in the control of hyperkalemia include insulin administration, 71 particularly in the hyperglycemic patient, and alkali administration if hypobicarbonatemia is present. 72 Sodium-free alkali preparations are under development to avoid the sodium load associated with sodium bicarbonate administration.…”

Section: Recommended Approachesmentioning

confidence: 99%

Renal Failure Patients in Disasters

Lempert

Kopp

2019

Disaster med. public health prep.

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Disasters occur regularly, and frequently large numbers of patients treated with maintenance dialysis or with the recent onset of acute kidney injury are put at risk owing to the lack of access to dialysis care precipitating also a kidney failure disaster. The absence of necessary dialysis treatments can result in excessive emergency department visits, hospitalizations, morbidity, or an early death. Those with kidney failure are often evaluated in disaster medical locations or hospitals without nephrologists in attendance. Here we offer guidance for medical personnel evaluating such patients so that dialysis-dependent individuals can be properly assessed and managed with the need for urgent dialysis recognized. A disaster dialysis triage system is proposed. (Disaster Med Public Health Preparedness. 2019;13:782–790)

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A Comparison of Insulin Doses for the Treatment of Hyperkalemia in Patients with Renal Insufficiency

Abstract: In patients with renal insufficiency and hyperkalemia, 5 units of insulin reduced serum potassium to the same extent as 10 units of insulin but with a lower rate of hypoglycemia. Further controlled studies are needed to confirm these findings.

Cited by 41 publications

References 24 publications

Blood glucose reduction in patients treated with insulin and dextrose for hyperkalaemia

Blood glucose reduction in patients treated with insulin and dextrose for hyperkalaemia

Decreasing Hypoglycemia following Insulin Administration for Inpatient Hyperkalemia

Renal Failure Patients in Disasters

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