Abstract
Treatment of hyperkalemia with intravenous insulin-dextrose is associated with a risk of hypoglycemia. We aimed to determine the factors associated with hypoglycemia (glucose < 3.9 mmol/L, or < 70 mg/dL) and the critical time window with the highest incidence. In a retrospective cohort study in a tertiary hospital network, we included 421 adult patients with a serum potassium ≥ 6.0 mmol/L who received insulin-dextrose treatment. The mean age was 70 years with 62% male predominance. The prevalence of diabetes was 60%, and 70% had chronic kidney disease (eGFR < 60 ml/min/1.73 m2). The incidence of hypoglycemia was 21%. In a multivariable logistic regression model, the factors independently associated with hypoglycemia were: body mass index (per 5 kg/m2, OR 0.85, 95% CI: 0.69–0.99, P = 0.04), eGFR < 60 mL/min/1.73 m2 (OR 2.47, 95% CI: 1.32–4.63, P = 0.005), diabetes (OR 0.57, 95% CI 0.33–0.98, P = 0.043), pre-treatment blood glucose (OR 0.84, 95% CI: 0.77–0.91, P < 0.001), and treatment in the emergency department compared to other locations (OR 2.53, 95% CI: 1.49–4.31, P = 0.001). Hypoglycemia occurred most frequently between 60 and 150 min, with a peak at 90 min. Understanding the factors associated with hypoglycemia and the critical window of risk is essential for the development of preventive strategies.
Highlights
Hyperkalemia is associated with the risk of cardiac arrhythmia and cardiac arrest
We identified the independent predictors of hypoglycemia as diabetes status, pre-Insulin-dextrose treatment (IDT) glucose, body mass index (BMI), eGFR < 60 ml/min/1.73 m2 and treatment location in ED
We looked at multiple blood glucose readings after IDT and were able to establish an accurate incidence of hypoglycemia and reliably determine the critical window for hypoglycemia
Summary
Hyperkalemia is associated with the risk of cardiac arrhythmia and cardiac arrest. Serum potassium levels above 6 mmol/L require urgent treatment to avoid cardiac instability[1,2]. Insulin-dextrose treatment (IDT) is a common first-line treatment for moderate (potassium 6 to 7 mmol/L) to severe hyperkalemia (potassium > 7 mmol/L). The variability in estimates is likely due to differences in the population studied, clinical setting, protocol for IDT, and the definition of hypoglycemia used. Most institutions have guidelines on the frequency and duration of blood glucose monitoring, but most studies have not defined the optimal protocol for monitoring. The primary aim of this study was to determine the incidence and severity of hypoglycemia following IDT for hyperkalemia, and to identify the risk factors for hypoglycemia using multivariable analysis. The secondary aim was to determine the timing of hypoglycemia and blood glucose trough following IDT as a means of evaluating the sufficiency of monitoring
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