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.
Highlights
Hyperkalemia is a common electrolyte imbalance usually associated with reduced renal excretion, altered cation exchange at the cellular level and/or excessive intake
In endstage renal disease (ESRD) emergency hemodialysis is the therapy of choice, while in patients with acute kidney injury (AKI), non-dialysis dependent chronic kidney disease (CKD) or normal renal function treatment should be directed at increasing K+ excretion via diuretics such as furosemide or ion-exchange resins such as calcium polystyrene sulfonate [6]
We identified 177 episodes where an intravenous infusion of insulin and glucose was administered to treat hyperkalemia
Summary
Hyperkalemia is a common electrolyte imbalance usually associated with reduced renal excretion, altered cation exchange at the cellular level and/or excessive intake. It has potential lifethreatening consequences [1, 2] and increases all-cause and in-hospital mortality [3,4,5]. We determined the incidence of hypoglycemia and severe hypoglycemia (blood glucose
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