PURPOSE:The aim of this study was to assess the incidence of hypoglycemia in hospitalized patients following acute treatment of hyperkalemia with insulin. A characterization of the affected patients and the administered insulin/dextrose regimens was also performed. METHODS:A retrospective search of the electronic records of a large university-based tertiary care hospital was
Hyperkalemia treatment with intravenous insulin has been associated with hypoglycemia. This single‐center, retrospective study compared the effects on hypoglycemia between weight‐based insulin dosing (0.1 U/kg of body weight up to a maximum of 10 U) compared to standard flat doses of 10 U among patients weighing less than 95 kg. Of the 132 charts randomly selected for review, hypoglycemic events (blood glucose <70 mg/dL) were reduced from 27.3% in the 10‐U group to 12.1% in the weight‐based group (P = 0.05). The number of affected patients was reduced with 19.7% in the 10‐U group and 10.6% in the weight‐based group (P = 0.22). The potassium‐lowering effects of these 2 strategies were similar between groups. Female patients and those with baseline glucose values <140 mg/dL were at increased risk for hypoglycemia. Weight‐based insulin dosing (0.1 U/kg) for acute hyperkalemia therapy resulted in less hypoglycemia without impacting potassium lowering. Journal of Hospital Medicine 2016;11:355–357. © 2016 Society of Hospital Medicine
Abbreviations: (A1C) hemoglobin A1c, (AUC) area under the curve, (BG) blood glucose, (EHR) electronic health record, (LSH) less severe hypoglycemia, (SH) severe hypoglycemia, (TDD) total daily dose Keywords: diabetes, inpatient hypoglycemia, patient safety, prediction, prevention
BACKGROUND Severe hypoglycemia (SH), defined as a blood glucose (BG) <40 mg/dL, is associated with an increased risk of adverse clinical outcomes in inpatients. OBJECTIVE To determine whether a predictive informatics hypoglycemia risk‐alert supported by trained nurse responders would reduce the incidence of SH in our hospital. DESIGN A 5‐month prospective cohort intervention study. SETTING Acute care medical floors in a tertiary care academic hospital in St. Louis, Missouri. PATIENTS From 655 inpatients on designated medical floors with a BG of <90 mg/dL, 390 were identified as high risk for hypoglycemia by the alert system. MEASUREMENTS The primary outcome was the incidence of SH occurring in high‐risk intervention versus high‐risk control patients. Secondary outcomes included: number of episodes of SH in all study patients, incidence of BG < 60 mg/dL and severe hyperglycemia with a BG >299 mg/dL, length of stay, transfer to a higher level of care, the frequency that high‐risk patient's orders were changed in response to the alert‐intervention process, and mortality. RESULTS The alert process, when augmented by nurse‐physician collaboration, resulted in a significant decrease by 68% in the rate of SH in alerted high‐risk patients versus nonalerted high‐risk patients (3.1% vs 9.7%, P = 0.012). Rates of hyperglycemia were similar on intervention and control floors at 28% each. There was no difference in mortality, length of stay, or patients requiring transfer to a higher level of care. CONCLUSION A real‐time predictive informatics‐generated alert, when supported by trained nurse responders, significantly reduced inpatient SH. Journal of Hospital Medicine 2014;9:621–626. © 2014 Society of Hospital Medicine
BACKGROUNDPhysician recognition of chronic kidney disease (CKD) in elderly patients has been noted to be poor. These patients are at increased risk of medication dosing errors and acute renal failure.OBJECTIVETo investigate the effect of reporting estimated glomerular filtration rate (GFR) of elderly hospitalized patients on physician recognition of CKD and physician prescribing behaviors.DESIGNA retrospective combined with a prospective medical record review project.SETTINGA large academic medical center.PATIENTSPatients included were 65 years of age or older and had creatinine values within the normal laboratory range (< 1.6 mg/dL).INTERVENTIONReporting a calculated estimate of GFR to physicians.MEASUREMENTSRates of recognition of CKD were examined before and after the intervention. The effects of the intervention on prescription of renal‐dosed antibiotics and nonsteroidal anti‐inflammatory drugs (NSAIDS) and cyclooxygenase‐ 2 inhibitors (COX‐2) at hospital discharge were assessed.RESULTSA total of 260 and 198 patients were included before and after the intervention, respectively. Recognition of chronic kidney disease was low in both groups but demonstrated a significant increase following reporting of estimated GFR (3.9% to 12.6%, P < .001). Reporting of GFR was not associated with a significant decrease in prescription of NSAID/COX‐2 medications or increased rates of correct dosing of antibiotics (P = .10 and P = .81, respectively).CONCLUSIONSAlthough reporting of estimated GFR was associated with improved physician recognition of CKD in elderly hospitalized patients, it did not lead to a change in physician prescribing. More extensive interventions are necessary to increase recognition and decrease medication dosing errors. Journal of Hospital Medicine 2007;2:74–78. © 2007 of Hospital Medicine.
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