Frequency of serum blood glucose monitoring after hyperkalaemia treatment using insulin and dextrose

Abstract

ObjectivesIn patients with hyperkalaemia, dextrose is administered alongside insulin treatment to prevent hypoglycaemia. However, the incidence of hypoglycaemia in the first 6 hours following this regimen remains high, and frequent blood glucose monitoring is essential. This study evaluates the frequency of blood glucose monitoring following this insulin regimen. MethodsThis retrospective, multicentre study evaluated adult patients (≥18 years) who had been hospitalised for hyperkalaemia (K ≥ 5 mEq/mL) and managed using intravenous insulin and dextrose. We excluded patients if dextrose was not administered within 60 minutes of insulin therapy. The primary outcome was the frequency of serum blood glucose monitoring within 6 hours of the regimen. Secondary outcomes were the time between insulin treatment and follow-up measurements, and the incidence of hypoglycaemia (blood glucose <70 mg/dL). ResultsIn total, 521 hyperkalaemia episodes were available for analysis; 192 (36.9%) had at least one reported follow-up measurement, 30 had at least two follow-up measurements (5.8%), and six had at least three follow-up measurements (1.2%). The median times of obtaining the first, second, and third blood glucose measurements were 3 h (interquartile range [IQR]: 1.7–4 h), 3.9 h (IQR: 3.2–5.1 h), and 4 h (IQR: 3.2–5.1 h), respectively. The incidence of hypoglycaemia among the episodes with follow-up was 4.8%. ConclusionsThe frequency of serum blood glucose monitoring following insulin therapy was low and inconsistent. This study emphasised the importance of adopting protocols incorporating more frequent blood glucose monitoring.