Hypoglycemia following intravenous insulin plus glucose for hyperkalemia in patients with impaired renal function

Abstract

BackgroundHypoglycemia is a serious complication following the administration of insulin for hyperkalemia. We determined the incidence of hypoglycemia and severe hypoglycemia (blood glucose <70 or ≤40 mg/dl, respectively) in a cohort of AKI and non-dialysis dependent CKD patients who received an intravenous infusion of insulin plus glucose to treat hyperkalemia.MethodsWe retrospectively reviewed charts of all AKI and non-dialysis dependent CKD patients who received 10 U of insulin plus 50 g glucose to treat hyperkalemia from December 1, 2013 to May 31, 2015 at our Department.ResultsOne hundred sixty four episodes of hyperkalemia were treated with insulin plus glucose and were eligible for analysis. Serum potassium levels dropped by 1.18 ± 1.01 mmol/l. Eleven treatments (6.1%) resulted in hypoglycemia and two (1.2%) in severe hypoglycemia. A lower pretreatment blood glucose tended to associate with a higher subsequent risk of hypoglycemia. Age, sex, renal function, an established diagnosis of diabetes or previous treatment were not associated with the development of this complication. We did not register any significant adverse events.ConclusionOur intravenous regimen combining an infusion of insulin plus glucose effectively reduced serum potassium levels compared to previous studies and associated a low risk of symptomatic hypoglycemia and other complications.

Evidence in support of hyperkalaemia management strategies: A systematic literature review

“…Of the 29 unique non‐randomised interventional studies identified in this SLR, 13 investigated temporising agents and 6 ZS or organic cation‐binding agents for the management of hyperkalaemia . Twelve out of 43 unique observational studies identified in the SLR reported on management of hyperkalaemia with SPS or CPS and 11 focused on temporising agents; however, a comparison of temporising agents was not in the scope of this work, given their use in the emergency setting …”

“…[56][57][58][59][60][61] Twelve out of 43 unique observational studies identified in the SLR reported on management of hyperkalaemia with SPS or CPS 62-73 and 11 focused on temporising agents; however, a comparison of temporising agents was not in the scope of this work, given their use in the emergency setting. [74][75][76][77][78][79][80][81][82][83][84] Non-systematic or narrative reviews Case reports Commentaries and editorials SLRs or network meta-analyses (NMAs) of relevant studies were included at title/abstract review stage for the purpose of identifying any additional studies not identified in the database searches, but subsequently excluded at full-text review stage…”

Preventing Hypoglycemia Following Treatment of Hyperkalemia in Hospitalized Patients

“…The reported incidence in hospitalized patients ranges from 6% to 75% depending on the population studied, the doses of insulin/ dextrose administered, and the definition of hypoglycemia. [5][6][7][8] Hypoglycemia itself is associated with increased morbidity and mortality in hospitalized patients. 9 The aims of this study were to describe the incidence of hypoglycemia following hyperkalemia treatment with intra-venous insulin/dextrose in inpatients in a large (900-bed) UK teaching hospital and to determine the risk factors predisposing to hypoglycemia.…”

Decreasing Hypoglycemia following Insulin Administration for Inpatient Hyperkalemia

“…Prior studies have likely underestimated the incidence of hyperkalemia treatment-associated hypoglycemia as glucose levels are rarely checked within three hours of insulin administration. 8 In our study, which was designed to ensure appropriate blood glucose measurement, 21% of insulin treatments for hyperkalemia resulted in hypoglycemia, with 92% of hypoglycemic events occurring within the first three hours.…”