Treatment of hyperkalemia using intravenous insulin can result in severe hypoglycemia, but regular blood glucose monitoring is not standardized. This study aimed to (i) explore the demographics of adult patients receiving hyperkalemia treatment and (ii) identify the incidence rate of hypoglycemia and associated demographic or clinical characteristics.
A descriptive design with prospective data collection was used. This study recruited 135 patients who received hyperkalemia treatment in the emergency department. Structured blood glucose monitoring was conducted at 1, 2, 4, and 6 hours after receiving intravenous insulin. Univariate analyses of association between demographic and clinical variables and hypoglycemia outcome were performed.
There were 31 hypoglycemic events, with 11.9%, 7.4%, 2.2%, and 1.5% occurring at the 1, 2, 4, and 6 hours after treatment. The logit regression showed no significantly increased risk of hypoglycemia in terms of the demographic and clinical variables.
The variation in blood glucose response observed in this study combined with the high incidences of hypolycaemia indicated the need for frequent and longer duration of monitoring for patients who were being treated for hyperkalaemia with IDT.
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- Mosby’s Manual of Diagnostic and Laboratory Tests-E-book.Elsevier Health Sciences, 2017
- Preventing hypoglycemia following treatment of hyperkalemia in hospitalized patients.J Hosp Med. 2019; 14: 284-287https://doi.org/10.12788/jhm.3145
- Hyperkalemia in the emergency department: etiology, symptoms and outcome of a life threatening electrolyte disorder.Eur J Intern Med. 2013; 24: e59-e60https://doi.org/10.1016/j.ejim.2013.02.010
- Incidence of hyperkalemia in the emergency department: a 10-year retrospective study.Intern Emerg Med. 2020; 15: 727-728https://doi.org/10.1007/s11739-019-02159-4
- Real world evidence for treatment of hyperkalemia in the emergency department (Reveal–ED): a multicenter, prospective, observational study.J Emerg Med. 2018; 55: 741-750https://doi.org/10.1016/j.jemermed.2018.09.007
- Hypoglycemia as a complication of intravenous insulin to treat hyperkalemia in the emergency department.Am J Emerg Med. 2019; 37: 209-213https://doi.org/10.1016/j.ajem.2018.05.016
- Clinical outcomes associated with the emergency treatment of hyperkalaemia with intravenous insulin-dextrose.Eur J Intern Med. 2022; 95: 87-92https://doi.org/10.1016/j.ejim.2021.09.018
- Incidence and causes of iatrogenic hypoglycemia in the emergency department.West J Emerg Med. 2019; 20: 833-837https://doi.org/10.5811/westjem.2019.7.42996
- Hypoglycemia in the treatment of hyperkalemia with insulin in patients with end-stage renal disease.Clin Kidney J. 2014; 7: 248-250https://doi.org/10.1093/ckj/sfu026
- Impact of dextrose dose on hypoglycemia development following treatment of hyperkalemia.Ther Adv Drug Saf. 2018; 9: 323-329https://doi.org/10.1177/2042098618768725
- Decreasing hypoglycemia following insulin administration for inpatient hyperkalemia.J Hosp Med. 2020; 15: 368-370https://doi.org/10.12788/jhm.3357
- Assessment of dextrose 50 bolus versus dextrose 10 infusion in the management of hyperkalemia in the ED.Am J Emerg Med. 2020; 38: 598-602https://doi.org/10.1016/j.ajem.2019.09.003
- Iatrogenic hypoglycaemia following glucose-insulin infusions for the treatment of hyperkalaemia.Clin Endocrinol (Oxf). 2021; 94: 176-182https://doi.org/10.1111/cen.14343
- MON-167 hypoglycemia prevention: a quality improvement project to reduce inpatient hypoglycemia rate following treatment of hyperkalemia.J Endocr Soc. 2019; 3 (MON-167. https://doi.org/10.1210/2Fjs.2019-MON-167)
- Hypoglycemia following intravenous insulin plus glucose for hyperkalemia in patients with impaired renal function.PLoS One. 2017; 12e0172961https://doi.org/10.1371/journal.pone.0172961
- Blood glucose reduction in patients treated with insulin and dextrose for hyperkalaemia.Emerg Med J. 2020; 37: 31-35https://doi.org/10.1136/emermed-2019-208744
- Hypoglycemia associated with insulin use during treatment of hyperkalemia among emergency department patients.Hosp Pharm. 2019; 54: 197-202https://doi.org/10.1177/0018578718779012
- Hypoglycemia and hyperglycemia are risk factors for falls in the hospital population.Acta Diabetol. 2019; 56: 931-938https://doi.org/10.1007/s00592-019-01323-8
- Risk factors, prevention and treatment of hypoglycaemia after hyperkalaemia in adult patients using intravenous insulin: an integrative review.Int J Nurs Pract. 2022; e13080https://doi.org/10.1111/ijn.13080
- The association of insulin-dextrose treatment with hypoglycemia in patients with hyperkalemia.Sci Rep. 2020; 1022044https://doi.org/10.1038/s41598-020-79180-7
- Reduced versus conventional dose insulin for hyperkalemia treatment.J Pharm Pract. 2020; 33: 262-266https://doi.org/10.1177/0897190018799220
- Incidence of hypoglycemia in patients with low eGFR treated with insulin and dextrose for hyperkalemia.Ann Pharmacother. 2015; 49: 1322-1326https://doi.org/10.1177/1060028015607559
- Treatment of hyperkalemia with a low-dose insulin protocol is effective and results in reduced hypoglycemia.Kidney Int Rep. 2018; 3: 328-336https://doi.org/10.1016/j.ekir.2017.10.009
- A comparison of insulin doses for the treatment of hyperkalemia in patients with renal insufficiency.Pharmacotherapy. 2017; 37: 1516-1522https://doi.org/10.1002/phar.2038
- Incidence of hypoglycemia following insulin-based acute stabilization of hyperkalemia treatment.J Hosp Med. 2012; 7: 239-242https://doi.org/10.1002/jhm.977
- European Resuscitation Council guidelines for resuscitation 2015: section 4. Cardiac arrest in special circumstances.Resuscitation. 2015; 95: 148-201https://doi.org/10.1016/j.resuscitation.2015.07.017
- Hyperkalemia.in: StatPearls. StatPearls Publishing, 2022
- Clinical practice guidelines: treatment of acute hyperkalaemia in adults.The Renal Association website, June 1, 2020https://ukkidney.org/sites/renal.org/files/RENAL%20ASSOCIATION%20HYPERKALAEMIA%20GUIDELINE%20-%20JULY%202022%20V2_0.pdfDate accessed: July 22, 2020
- Guideline for the management of acute hyperkalaemia in adults.NHS, 2022 (February 4, 2019)https://www.nhsgrampian.org/globalassets/foidocument/foi-public-documents1---all-documents/Guide_Hyperkalaemia.pdfDate accessed: October 3, 2022
- Guidelines for the emergency treatment of hyperkalaemia. NHS foundation trust,
2019 (February 1, 2019)http://www.just.edu.jo/DIC/ClinicGuidlines/Guidelines%20for%20the%20Emergency%20Treatment%20of%20Hyperkalaemia.pdfDate accessed: July 22, 2020
- Point-of-care blood glucose meter accuracy in the hospital setting.Diabetes Spectr. 2014; 27: 174-179https://doi.org/10.2337/diaspect.27.3.174
- Assessing the impact of an order panel utilizing weight-based insulin and standardized monitoring of blood glucose for patients with hyperkalemia.Am J Med Qual. 2018; 33: 598-603https://doi.org/10.1177/1062860618764610
- Emergency management of severe hyperkalemia: guideline for best practice and opportunities for the future.Pharmacol Res. 2016; 113: 585-591https://doi.org/10.1016/j.phrs.2016.09.039
- Nurses’ perceptions of reasons for persistent low rates in hand hygiene compliance.Intensive Crit Care Nurs. 2017; 42: 17-21https://doi.org/10.1016/j.iccn.2017.02.005
Siew Hoon Lim is an Assistant Nurse Clinician, Division of Nursing, Singapore General Hospital, Singapore, Singapore. ORCID identifier: http://orcid.org/0000-0002-9559-0909.
Siti Namira Binte Abdul Wahab is a Senior Staff Nurse, Division of Nursing, Singapore General Hospital, Singapore, Singapore.
Shin Yuh Ang is a Deputy Director, Division of Nursing, Singapore General Hospital, Singapore, Singapore. ORCID identifier: http://orcid.org/0000-0001-9614-7012.
Ming Ming Teh is a Senior Consultant Endocrinologist, Department of Endocrinology, Singapore General Hospital, Singapore, Singapore.
Fazila Aloweni is a Senior Nurse Manager, Division of Nursing, Singapore General Hospital, Singapore, Singapore. ORCID identifier: http://orcid.org/0000-0001-8435-5068.
Published online: October 18, 2022
© 2022 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.