Search

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.

Objectives To determine if liver cirrhosis is associated with reduced efficacy of insulin-glucose treatment in moderate to severe hyperkalaemia. Design Retrospective, cohort study. Setting Two secondary and one tertiary care hospital at a large metropolitan healthcare network in Melbourne, Australia. Participants This study included 463 adults with a mean age of 68.7+/-15.8 years, comprising 79 patients with cirrhosis and 384 without cirrhosis as controls, who received standard insulin-glucose treatment for a serum potassium >=6.0 mmol/L from October 2016 to March 2020. Patients were excluded if they received an insulin infusion, or if there was inadequate follow-up data for at least 6 hours after IDT due to death, lost to follow-up or inadequate biochemistry monitoring. The mean Model for End-stage Liver Disease score in patients with cirrhosis was 22.2+/-7.5, and the distribution of the Child-Pugh score for cirrhosis was: class A (24%), class B (46%), class C (30%). Outcome measures The primary outcome was the degree of potassium lowering and the secondary outcome was the proportion of patients who achieved normokalaemia, within 6 hours of treatment. Results The mean pretreatment potassium for the cohort was 6.57+/-0.52 mmol/L. After insulin-glucose treatment, mean potassium lowering was 0.84+/-0.58 mmol/L in patients with cirrhosis compared with 1.33+/-0.75 mmol/L for controls (p<0.001). The proportion of patients achieving normokalaemia was 33% for patients with cirrhosis, compared with 53% for controls (p=0.001). By multivariable regression, on average, liver cirrhosis was associated with a reduced potassium lowering effect of 0.42 mmol/L (95% CI 0.22 to 0.63 mmol/L, p<0.001) from insulin-glucose treatment, after adjusting for age, serum creatinine, cancer, pretreatment potassium level, beta-blocker use and cotreatments (sodium polystyrene sulfonate, salbutamol, sodium bicarbonate). Conclusions Our observational data suggest reduced efficacy of insulin-glucose

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.