Management of Hyperkalemia With Insulin and Glucose: Pearls for the Emergency Clinician
Kayvan Moussavi, Scott Fitter, Stephen Walter Gabrielson, Alex Koyfman, Brit Long
Background: Hyperkalemia is a common, potentially lethal clinical condition that accounts for a significant number of emergency department (ED) visits. Insulin and dextrose are frequently used to manage patients with hyperkalemia. Objective: This narrative review evaluates several myths concerning hyperkalemia treatment with insulin and dextrose in the ED and provides recommendations based on the current evidence. Discussion: Hyperkalemia is a life-threatening condition requiring emergent therapy. One of these therapies includes insulin with glucose. However, hypoglycemia after insulin use is a frequent complication during hyperkalemia management. The published literature suggests that low pretreatment glucose, no history of diabetes mellitus, female gender, abnormal renal function, and lower body weight increase the risk of hypoglycemia. Several strategies can reduce the risk of hypoglycemia with insulin therapy, which include using insulin 5 units or 0.1 units/kg instead of 10 units, administering dextrose 50 g instead of 25 g, or administering dextrose as a prolonged infusion instead of a rapid intravenous bolus. Because insulin may have a duration of action that exceeds dextrose, patients receiving insulin for hyperkalemia should be monitored for hypoglycemia hourly for at least 4–6 h after administration. Conclusion: Several myths surround hyperkalemia management with insulin and dextrose. This review evaluates the evidence concerning insulin and glucose for hyperkalemia and suggests several modifications to insulin and dextrose dosing to reduce the risk of hypoglycemia.
Journal of Emergency Medicine
https://doi.org/10.1016/j.jemermed.2019.03.043
adverse drug event
10.1016/j.jemermed.2019.03.043
Dive into the research topics of 'Management of Hyperkalemia With Insulin and Glucose: Pearls for the Emergency Clinician'. Together they form a unique fingerprint.
Hyperkalemia Medicine & Life Sciences 100%
Emergencies Medicine & Life Sciences 62%
Glucose Medicine & Life Sciences 50%
Hypoglycemia Medicine & Life Sciences 35%
Hospital Emergency Service Medicine & Life Sciences 11%
Diabetes Mellitus Medicine & Life Sciences 5%
Body Weight Medicine & Life Sciences 5%
Moussavi, K., Fitter, S., Gabrielson, S. W., Koyfman, A., & Long, B. (2019). Management of Hyperkalemia With Insulin and Glucose: Pearls for the Emergency Clinician. Journal of Emergency Medicine, 57(1), 36-42. https://doi.org/10.1016/j.jemermed.2019.03.043
Management of Hyperkalemia With Insulin and Glucose : Pearls for the Emergency Clinician. / Moussavi, Kayvan; Fitter, Scott; Gabrielson, Stephen Walter et al.
In: Journal of Emergency Medicine, Vol. 57, No. 1, 07.2019, p. 36-42.
Moussavi, K, Fitter, S, Gabrielson, SW, Koyfman, A & Long, B 2019, 'Management of Hyperkalemia With Insulin and Glucose: Pearls for the Emergency Clinician', Journal of Emergency Medicine, vol. 57, no. 1, pp. 36-42. https://doi.org/10.1016/j.jemermed.2019.03.043
Moussavi K, Fitter S, Gabrielson SW, Koyfman A, Long B. Management of Hyperkalemia With Insulin and Glucose: Pearls for the Emergency Clinician. Journal of Emergency Medicine. 2019 Jul;57(1):36-42. doi: 10.1016/j.jemermed.2019.03.043
Moussavi, Kayvan ; Fitter, Scott ; Gabrielson, Stephen Walter et al. / Management of Hyperkalemia With Insulin and Glucose : Pearls for the Emergency Clinician. In: Journal of Emergency Medicine. 2019 ; Vol. 57, No. 1. pp. 36-42.
@article{85352950e0e84d59bb686a77e2e297e2,
title = "Management of Hyperkalemia With Insulin and Glucose: Pearls for the Emergency Clinician",
abstract = "Background: Hyperkalemia is a common, potentially lethal clinical condition that accounts for a significant number of emergency department (ED) visits. Insulin and dextrose are frequently used to manage patients with hyperkalemia. Objective: This narrative review evaluates several myths concerning hyperkalemia treatment with insulin and dextrose in the ED and provides recommendations based on the current evidence. Discussion: Hyperkalemia is a life-threatening condition requiring emergent therapy. One of these therapies includes insulin with glucose. However, hypoglycemia after insulin use is a frequent complication during hyperkalemia management. The published literature suggests that low pretreatment glucose, no history of diabetes mellitus, female gender, abnormal renal function, and lower body weight increase the risk of hypoglycemia. Several strategies can reduce the risk of hypoglycemia with insulin therapy, which include using insulin 5 units or 0.1 units/kg instead of 10 units, administering dextrose 50 g instead of 25 g, or administering dextrose as a prolonged infusion instead of a rapid intravenous bolus. Because insulin may have a duration of action that exceeds dextrose, patients receiving insulin for hyperkalemia should be monitored for hypoglycemia hourly for at least 4–6 h after administration. Conclusion: Several myths surround hyperkalemia management with insulin and dextrose. This review evaluates the evidence concerning insulin and glucose for hyperkalemia and suggests several modifications to insulin and dextrose dosing to reduce the risk of hypoglycemia.",
keywords = "adverse drug event, hyperkalemia, hypoglycemia, insulin, renal impairment",
author = "Kayvan Moussavi and Scott Fitter and Gabrielson, {Stephen Walter} and Alex Koyfman and Brit Long",
note = "Funding Information: MB, BL, and AK conceived the idea for this article and contributed substantially to the writing and editing of the review. This article did not use any grants or funding, and it has not been presented in abstract form. This clinical review has not been published, it is not under consideration for publication elsewhere, its publication is approved by all authors and tacitly or explicitly by the responsible authorities where the work was carried out, and that, if accepted, it will not be published elsewhere in the same form, in English or in any other language, including electronically without the written consent of the copyright-holder. This review does not reflect the views or opinions of the U.S. Government, Department of Defense, U.S. Army, U.S. Air Force, Brooke Army Medical Center, or SAUSHEC EM Residency Program. Publisher Copyright: {\textcopyright} 2019",
doi = "10.1016/j.jemermed.2019.03.043",
journal = "Journal of Emergency Medicine",
T1 - Management of Hyperkalemia With Insulin and Glucose
T2 - Pearls for the Emergency Clinician
AU - Moussavi, Kayvan
AU - Fitter, Scott
AU - Gabrielson, Stephen Walter
AU - Koyfman, Alex
AU - Long, Brit
N1 - Funding Information: MB, BL, and AK conceived the idea for this article and contributed substantially to the writing and editing of the review. This article did not use any grants or funding, and it has not been presented in abstract form. This clinical review has not been published, it is not under consideration for publication elsewhere, its publication is approved by all authors and tacitly or explicitly by the responsible authorities where the work was carried out, and that, if accepted, it will not be published elsewhere in the same form, in English or in any other language, including electronically without the written consent of the copyright-holder. This review does not reflect the views or opinions of the U.S. Government, Department of Defense, U.S. Army, U.S. Air Force, Brooke Army Medical Center, or SAUSHEC EM Residency Program. Publisher Copyright: © 2019
N2 - Background: Hyperkalemia is a common, potentially lethal clinical condition that accounts for a significant number of emergency department (ED) visits. Insulin and dextrose are frequently used to manage patients with hyperkalemia. Objective: This narrative review evaluates several myths concerning hyperkalemia treatment with insulin and dextrose in the ED and provides recommendations based on the current evidence. Discussion: Hyperkalemia is a life-threatening condition requiring emergent therapy. One of these therapies includes insulin with glucose. However, hypoglycemia after insulin use is a frequent complication during hyperkalemia management. The published literature suggests that low pretreatment glucose, no history of diabetes mellitus, female gender, abnormal renal function, and lower body weight increase the risk of hypoglycemia. Several strategies can reduce the risk of hypoglycemia with insulin therapy, which include using insulin 5 units or 0.1 units/kg instead of 10 units, administering dextrose 50 g instead of 25 g, or administering dextrose as a prolonged infusion instead of a rapid intravenous bolus. Because insulin may have a duration of action that exceeds dextrose, patients receiving insulin for hyperkalemia should be monitored for hypoglycemia hourly for at least 4–6 h after administration. Conclusion: Several myths surround hyperkalemia management with insulin and dextrose. This review evaluates the evidence concerning insulin and glucose for hyperkalemia and suggests several modifications to insulin and dextrose dosing to reduce the risk of hypoglycemia.
AB - Background: Hyperkalemia is a common, potentially lethal clinical condition that accounts for a significant number of emergency department (ED) visits. Insulin and dextrose are frequently used to manage patients with hyperkalemia. Objective: This narrative review evaluates several myths concerning hyperkalemia treatment with insulin and dextrose in the ED and provides recommendations based on the current evidence. Discussion: Hyperkalemia is a life-threatening condition requiring emergent therapy. One of these therapies includes insulin with glucose. However, hypoglycemia after insulin use is a frequent complication during hyperkalemia management. The published literature suggests that low pretreatment glucose, no history of diabetes mellitus, female gender, abnormal renal function, and lower body weight increase the risk of hypoglycemia. Several strategies can reduce the risk of hypoglycemia with insulin therapy, which include using insulin 5 units or 0.1 units/kg instead of 10 units, administering dextrose 50 g instead of 25 g, or administering dextrose as a prolonged infusion instead of a rapid intravenous bolus. Because insulin may have a duration of action that exceeds dextrose, patients receiving insulin for hyperkalemia should be monitored for hypoglycemia hourly for at least 4–6 h after administration. Conclusion: Several myths surround hyperkalemia management with insulin and dextrose. This review evaluates the evidence concerning insulin and glucose for hyperkalemia and suggests several modifications to insulin and dextrose dosing to reduce the risk of hypoglycemia.
KW - adverse drug event
KW - hyperkalemia
KW - hypoglycemia
KW - renal impairment
U2 - 10.1016/j.jemermed.2019.03.043
DO - 10.1016/j.jemermed.2019.03.043
JO - Journal of Emergency Medicine
JF - Journal of Emergency Medicine