UMEM Educational Pearls

Category: Pharmacology & Therapeutics

Title: Prevent Hypoglycemia when Treating Hyperkalemia

Keywords: hypoglycemia, hyperkalemia (PubMed Search)

Posted: 2/2/2019 by Ashley Martinelli (Updated: 12/7/2019)
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Takeaways

A recent retrospective study examined the incidence of hypoglycemia for 1307 adult patient encounters with hyperkalemia (>5.3 mmol/L) over a five-year timeframe.
 
409 (31%) of patients were treated with IV insulin.
Within 3 hours of insulin administration:
-344/409 (84%) had a glucose test
-68/409 (17%) experienced hypoglycemia (glucose <70 mg/dL)
-31/409 (8%) experienced severe hypoglycemia (glucose < 50 mg/dL)
 
Patients with serum glucose <100mg/dL prior to insulin administration experienced even higher rates of hypoglycemia, 38/112 (34%).
 
Patients who did not receive IV insulin had a hypoglycemia rate of 4%.
 
In patients with critical illness, a single episode of hypoglycemia has been independently associated with increased mortality.  Ensure patients receive adequate dextrose loading doses based on their pre-insulin blood glucose and monitor point of care glucose every 30-60 minutes for the first 3 hours of care. Use automated order sets when available.

In-Depth

References

Scott NL, Klein LR, Cales E, Driver BE. Hypoglycemia as a complication of intravenous insulin to treat hyperkalemia in the emergency department. Am J Emerg Med. 2019;37(2):209-213.