Reduced Versus Conventional Dose Insulin for Hyperkalemia Treatment

Abstract

Conventional dose insulin may be more effective than reduced dose regular insulin at baseline serum potassium levels >6 mmol/L in the treatment of hyperkalemia. Frequent monitoring of serum potassium and glucose after administration of insulin is necessary to confirm adequate response and avoidance of hypoglycemia.

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

“…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.…”

“…[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.…”

“…[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.…”

The Association of Insulin-dextrose Treatment with Hypoglycemia in Patients with Hyperkalemia

“…It is not clear which is the best approach to reduce hypoglycemia risk. Insulin dose reduction has been suggested in patients with advanced CKD 5,7,8,30,31 . Two studies have compared hypoglycemia incidence in patients with CKD receiving 5 U versus 10 U of insulin.…”

Review: Management of Hyperkalemia in Kidney Transplant Recipients

“…Conversely, one study reported that an insulin dose of 5 units significantly reduced the risk of hypoglycemia compared with 10 units, with an increase in serum creatinine being associated with an increased risk for hypoglycemia. [36] Farina et al [37] concluded that the use of 50 g of dextrose instead of 25 g did not reduce hypoglycemia incidence. It should be noted that the evidence is limited by small cohort sizes and retrospective design.…”