Assessment of intravenous insulin dosing strategies for the treatment of acute hyperkalemia in the emergency department

Keeney, Katherine Preston; Calhoun, Chara; Jennings, Lindsey; Weeda, Erin R.; Weant, Kyle A.

doi:10.1016/j.ajem.2019.158374

Cited by 11 publications

(14 citation statements)

References 20 publications

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“…Unmeasured confounders within each included study could have influenced the results of the meta-analysis. Time for hypoglycemia screening after insulin administration also varied between studies and ranged from 4 to 24 h. [26][27][28][29][30][31][32][33][34][35] Hypoglycemia has been observed up to 24 h after administration of standard and alternative insulin doses. 32 Studies that had shorter screening times after insulin administration may have underreported hypoglycemia.…”

Section: Discussionmentioning

confidence: 99%

“…Study characteristics are summarized in Table 1. [26][27][28][29][30][31][32][33][34][35] All articles included in the analysis were observational cohort studies conducted at single medical centers and only included adult patients. No interventional trials were included.…”

Section: Description Of Eligible Studiesmentioning

confidence: 99%

“…Risk of bias assessment for each study is summarized in Table 2. [26][27][28][29][30][31][32][33][34][35] Overall, included studies had low to moderate risk of bias. Studies with moderate risk of bias had uncertainty related to patient inclusion, demonstration that hypoglycemia was not present prior to insulin administration, and adequacy of time to assess for efficacy and safety-related outcomes after insulin administration.…”

Section: Description Of Eligible Studiesmentioning

confidence: 99%

“…[23][24][25] Administration of a reduced alternative insulin dose has emerged as a potential option during hyperkalemia treatment. [26][27][28][29][30][31][32][33][34][35] Alternative insulin dose refers to administration of doses less than 10 units, such as 5 units or 0.1 units per kilogram. [26][27][28][29][30][31][32][33] Alternative insulin doses have been associated with reduced risk of hypoglycemia when compared to doses of 10 units; however, effects on potassium are less clear as studies have shown diminished, increased, or no difference in reduction.…”

Section: Introductionmentioning

confidence: 99%

“…[26][27][28][29][30][31][32][33][34][35] Alternative insulin dose refers to administration of doses less than 10 units, such as 5 units or 0.1 units per kilogram. [26][27][28][29][30][31][32][33] Alternative insulin doses have been associated with reduced risk of hypoglycemia when compared to doses of 10 units; however, effects on potassium are less clear as studies have shown diminished, increased, or no difference in reduction. [26][27][28][29][30][31][32][33][34][35] The purpose of this meta-analysis was to address these conflicting results and determine the impact of alternative insulin doses on hypoglycemia and potassium reduction during hyperkalemia management.…”

Section: Introductionmentioning

confidence: 99%

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Reduced alternative insulin dosing in hyperkalemia: A meta‐analysis of effects on hypoglycemia and potassium reduction

et al. 2021

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Study Objective: Recent studies have identified that reduced alternative intravenous insulin doses, such as 5 units or 0.1 units/kg, may reduce the risk of hypoglycemia compared to standard doses of 10 units in patients treated for hyperkalemia.However, some studies suggest that these alternative doses may reduce the ability to lower serum potassium. This study was performed to determine the impact of alternative insulin dosing on hypoglycemia and potassium reduction in patients with hyperkalemia.

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Section: Discussionmentioning

confidence: 99%

Section: Description Of Eligible Studiesmentioning

confidence: 99%

Section: Description Of Eligible Studiesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Reduced alternative insulin dosing in hyperkalemia: A meta‐analysis of effects on hypoglycemia and potassium reduction

et al. 2021

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A Retrospective Analysis of Intravenous Insulin versus Insulin and Nebulized Albuterol for the Treatment of Hyperkalemia in the Emergency Department

Roach,

Fletcher,

Sarangarm

2024

The Journal of Clinical Pharma

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There is limited literature evaluating nebulized albuterol in hyperkalemia management. The objective was to evaluate the efficacy of insulin alone compared to the addition of nebulized albuterol for the treatment of hyperkalemia. This is a retrospective, single‐center evaluation of adult patients with hyperkalemia at a large urban academic medical center Emergency Department. Consecutive patients with a potassium level greater than 5 mmol/L were included. Patients without a repeat potassium level within 4 hours of medication administration, those receiving hemodialysis before a repeat serum potassium, or those that had a hemolyzed blood sample were excluded. The primary outcome was the change in potassium level within 4 hours between patients who received insulin monotherapy versus insulin and albuterol. The secondary outcomes included hospital length of stay, intensive care unit admission, and mortality. Out of the 204 patients, 141 received insulin while 63 received insulin and nebulized albuterol. There was no difference in the change in potassium between the insulin versus insulin and nebulized albuterol groups (0.85±0.6 vs. 0.96±0.78 mmol/L, p = 0.36). There was no difference in median hospital length of stay (8.6 IQR 13.2 vs. 5.6 IQR 8.2 days, p = 0.09), ICU admission (31.9% vs 38.1%, p = 0.39), and all‐cause mortality (14.9% vs 17.5%, p = 0.64). In this retrospective analysis, the addition of albuterol to insulin for the treatment of hyperkalemia did not result in a greater change in potassium within 4 hours of therapy.This article is protected by copyright. All rights reserved

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Correction of Electrolyte Abnormalities in Critically Ill Patients

Bulloch,

Cardinale-King,

Cogle

et al. 2024

Intensive Care Res

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Introduction The majority of patients in the intensive care unit (ICU) are at risk for at least one electrolyte abnormality and critically ill patients are the most vulnerable population to the effects of suboptimal electrolyte levels. These patients have unique characteristics impacting implications of the electrolyte disturbances and management. Areas Covered In the ICU, magnesium, potassium, calcium, phosphorous, and sodium are the most commonly encountered electrolytes that can be abnormal in the critically ill. Critical illness both is affected by and affects disturbances of these electrolytes which can result in more severe illness, longer duration of mechanical ventilation, increased dialysis support, longer length of stay, and increased mortality. Often, patients have multiple imbalances that require correction. Removal or mitigation of the cause should be undertaken whenever possible and should be concurrent with any therapeutic management used to correct the electrolyte imbalance. Selection of medication to correct electrolyte imbalances should be undertaken according to available evidence and drug-specific characteristics that impact medication delivery in the critically ill. Electrolyte disturbances, measurements, and corrections are ubiquitous in the ICU. Published literature on the management of electrolytes in the critically ill is limited. Management should consider factors unique to the critically ill when selecting optimal treatment approach and it is essential to individualize treatment to a patient’s unique needs and adapt management to the patient’s chancing clinical situation.

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Assessment of intravenous insulin dosing strategies for the treatment of acute hyperkalemia in the emergency department

Cited by 11 publications

References 20 publications

Reduced alternative insulin dosing in hyperkalemia: A meta‐analysis of effects on hypoglycemia and potassium reduction

Reduced alternative insulin dosing in hyperkalemia: A meta‐analysis of effects on hypoglycemia and potassium reduction

A Retrospective Analysis of Intravenous Insulin versus Insulin and Nebulized Albuterol for the Treatment of Hyperkalemia in the Emergency Department

Correction of Electrolyte Abnormalities in Critically Ill Patients

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