Abstract: FR-PO655
Detection of Hypoglycemia Incidents After Hyperkalemia Treatment with Dextrose 50% and Insulin
Session Information
- Fluid and Electrolytes: Clinical - Potassium, Sodium, Water
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Fluid and Electrolytes
- 902 Fluid and Electrolytes: Clinical
Authors
- Mansour, Mohamed, Ascension St John Hospital, Detroit, Michigan, United States
- Boshara, Peter, Ascension St John Hospital, Detroit, Michigan, United States
- Hamdi, Mohammed Ikram, Ascension St John Hospital, Detroit, Michigan, United States
- Szpunar, Susan M., St.John Hospital & Medical Center, Grosse Pointe Woods, Michigan, United States
- Topf, Joel M., St. Clair Nephrology, Roseville, Michigan, United States
Background
Hypoglycemia is a potential complication following hyperkalemia treatment with insulin. Most of the previous trials studied this risk in patients with decreased GFR. Our study assessed the incidence of hypoglycemia and its associated risk factors in patients with normal and decreased kidney function.
Methods
We conducted a retrospective study of hospitalized adult patients at a large community hospital who had hyperkalemia [potassium >5.4mmol/L] and were treated with intravenous insulin and dextrose 50%. We identified the incidence of hypoglycemia [blood glucose<70mg/dL] within six hours of insulin administration.
Results
142 patients were eligible for analysis. 25 patients (17.6%) developed hypoglycemia. Hypoglycemia was detected at a median of 105 minutes after insulin administration. Factors associated with a higher risk of hypoglycemia included lower body mass index mean(25.2±8.2vs.30.3±9.2)p=0.01, no history of diabetes OR 5.16, 95%CI:1.67-16.0;p=0.002, and patients who didn’t receive co-treatment with Polystyrene sulfonate [p=0.047]. Patients with hypoglycemia had lower pre-treatment glucose levels comparted to patients who did not mean(96.9±50.5vs.154.7±87.8)p=<0.0001.
Previous trials showed a lower risk of hypoglycemia in patients who received co-treatment with albuterol. Our study showed a non-significant trend toward higher risk of hypoglycemia in patients who received albuterol co-treatment [n=19 (20.3%) vs.n=10 (14.7%);p=0.384].
There was no difference hypoglycemia incidents in patients with normal kidney function versus patients with decreased kidney function, [normal kidney function vs. acute kidney injury p=0.98; normal kidney function vs. ESRD p=0.93]. There was no significant difference in the mean eGFR in hypoglycemic versus non-hypoglycemic patients (24.75±32.4vs.24.89±26.0)p=0.98.
Conclusion
Patients with lower BMI and no history of diabetes were at a significantly higher risk for hypoglycemia. This is maybe explained by a lack of insulin resistance associated with low BMI and non-diabetic status. Lower pretreatment glucose levels were associated with hypoglycemia. Hypoglycemia was most likely to develop within 1-3 hours of treatment.
This study supports the recommendations of frequent blood glucose monitoring following hyperkalemia treatment with intravenous insulin. Identifying risk factors is crucial