Treatment of Hyperkalemia With a Low-Dose Insulin Protocol Is Effective and Results in Reduced Hypoglycemia

McNicholas, Bairbre; Pham, Mai H.; Carli, Katrina; Chen, Chang Huei; Colobong-Smith, Nancy; Anderson, Arthur Eric; Pham, Hien

doi:10.1016/j.ekir.2017.10.009

Cited by 37 publications

(59 citation statements)

References 39 publications

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“…The recorded incidence of hypoglycaemia (22%), severe hypoglycaemia (6%) and the median time to detection of hypoglycaemia (108 min) in our study is consistent with previous reports 5 9–13 15–18. The increased prevalence of hypoglycaemia in our sample compared with other cohorts may reflect the exclusion of patients receiving therapies such as dextrose containing intravenous solutions and albuterol that are expected to be protective against the development of hypoglycaemia and were not adequately controlled in previous samples.…”

Section: Discussionsupporting

confidence: 89%

“…In 46 patients (51%) this was obtained from a repeat metabolic panel suggesting the intent was to monitor potassium lowering and not necessarily blood glucose. The use of electronic order sets to guide the management of hyperkalaemia reduced the incidence of hypoglycaemia but had no effect on the frequency of blood glucose monitoring 13 18. Together with our results, this suggests that increased awareness of the incidence of hypoglycaemia and the need for appropriate monitoring is desirable even in institutions using protocols to guide hyperkalaemia treatment.…”

Section: Discussionsupporting

confidence: 59%

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Blood glucose reduction in patients treated with insulin and dextrose for hyperkalaemia

et al. 2019

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BackgroundDextrose is commonly administered with insulin during the management of hyperkalaemia to avoid hypoglycaemia. Previous research has evaluated the incidence of hypoglycaemia; however, none have reported the extent of blood glucose reduction after this regimen. The aim of this study was to better characterise the changes in blood glucose and to identify patients who may have an increased response to insulin.MethodsThis was a multicentre retrospective study evaluating adult patients who received a regimen of 10 units of intravenous regular insulin plus 25 g of intravenous dextrose to manage hyperkalaemia between January 2014 and September 2016. The primary outcome was to evaluate the extent of blood glucose reduction (milligram per decilitre) up to 6 hours following the above regimen. Secondary outcomes included incidence of hypoglycaemia (blood glucose <70 mg/dL) and severe hypoglycaemia (blood glucose <40 mg/dL), and predictors of the extent of blood glucose reduction.ResultsA total of 90 patients were included. The median blood glucose change over 6 hours was −24 mg/dL (IQR −53 to 6 mg/dL). Hypoglycaemia developed in 20 patients (22.2%, 95% CI 14.1% to 32.2%) and five patients (5.6%, 95% CI 1.8% to 12.5%) had severe hypoglycaemia. Patients who developed hypoglycaemia had a median baseline blood glucose of 110 mg/dL (IQR 80 to 127 mg/dL), which decreased to a median value of 52 mg/dL (IQR 40 to 60 mg/dL). Higher baseline blood glucose was significantly associated with greater blood glucose reduction (coefficient −0.36, 95% CI −0.55 to −0.18, p<0.001).ConclusionsThe extent of blood glucose reduction is variable and hypoglycaemia is common. The high incidence of hypoglycaemia highlights the importance of frequent blood glucose monitoring.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 59%

Blood glucose reduction in patients treated with insulin and dextrose for hyperkalaemia

et al. 2019

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“…195 Administration of 5 units of regular insulin appears as effective in lowering potassium concentration as the administration of 10 units, although evidence is limited; hypoglycemia is a potential complication. 197,198 In addition, or as an alternative to insulinglucose, administration of b-agonists is suggested. 195 Use of 10 mg salbutamol via nebulizer results in significant reduction of potassium at a peak of 120 minutes after use (90 minutes for 20 mg).…”

Section: Acute Hyperkalemiamentioning

confidence: 99%

Potassium homeostasis and management of dyskalemia in kidney diseases: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Clase

Carrero

Ellison

et al. 2020

Kidney International

315

303

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“…Thus, a reduced (i.e. 5 units vs. 10 units) dose of regular insulin [ 99 ] or a weight-based intravenous insulin dose (0.1 units/Kg up to a maximum 10 units) [ 100 ] have been advocated as preferential protocols to treat severe HK in patients with or without CKD/ESRD. The use of short-acting vs. regular insulin has also been investigated, but deserves further studies [ 92 ].…”

Section: The Treatment Of Severe Hyperkalemiamentioning

confidence: 99%

Management of hyperkalemia in patients with kidney disease: a position paper endorsed by the Italian Society of Nephrology

Bianchi

Aucella

Nicola³

et al. 2019

J Nephrol

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Hyperkalemia (HK) is the most common electrolyte disturbance observed in patients with kidney disease, particularly in those in whom diabetes and heart failure are present or are on treatment with renin-angiotensin-aldosterone system inhibitors (RAASIs). HK is recognised as a major risk of potentially life threatening cardiac arrhythmic complications. When an acute reduction of renal function manifests, both in patients with chronic kidney disease (CKD) and in those with previously normal renal function, HK is the main indication for the execution of urgent medical treatment and the recourse to extracorporeal replacement therapies. In patients with end-stage renal disease, the presence of HK not responsive to medical therapy is an indication at the beginning of chronic renal replacement therapy. HK can also be associated indirectly with the progression of CKD, because the finding of high potassium values leads to withdrawal of treatment with RAASIs, which constitute the first choice nephro-protective treatment. It is therefore essential to identify patients at risk of developing HK, and to implement therapeutic interventions aimed at preventing and treating this dangerous complication of kidney disease. Current strategies aimed at the prevention and treatment of HK are still unsatisfactory, as evidenced by the relatively high prevalence of HK also in patients under stable nephrology care, and even in the ideal setting of randomized clinical trials where optimal treatment and monitoring are mandatory. This position paper will review the main therapeutic interventions to be implemented for the prevention, detection and treatment of HK in patients with CKD on conservative care, in those on dialysis, in patients in whom renal disease is associated with diabetes, heart failure, resistant hypertension and who are on treatment with RAASIs, and finally in those presenting with severe acute HK.

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Treatment of Hyperkalemia With a Low-Dose Insulin Protocol Is Effective and Results in Reduced Hypoglycemia

Cited by 37 publications

References 39 publications

Blood glucose reduction in patients treated with insulin and dextrose for hyperkalaemia

Blood glucose reduction in patients treated with insulin and dextrose for hyperkalaemia

Potassium homeostasis and management of dyskalemia in kidney diseases: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Management of hyperkalemia in patients with kidney disease: a position paper endorsed by the Italian Society of Nephrology

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