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Abstract: FR-PO646

Insulin Use for the Treatment of Acute Hyperkalemia

Session Information

Category: Fluid and Electrolytes

  • 902 Fluid and Electrolytes: Clinical


  • Humphrey, Toby Jl, University of Cambridge, Cambridge, United Kingdom
  • Wilkinson, Ian, University of Cambridge, Cambridge, United Kingdom
  • Hiemstra, Thomas F., University of Cambridge, Cambridge, United Kingdom

Insulin has been the cornerstone of treatment for hyperkalaemia (HK) for many decades and remains in wide clinical use. Despite this, there is a paucity of data on the efficacy and safety of this approach. To investigate this, we interrogated a large electronic health record (EHR) dataset to explore the characteristics and consequences of insulin treatment for HK.


Patients receiving insulin for the treatment of HK were identified from a complete EHR database of all admissions to a UK tertiary hospital over 3.5 years. Variables extracted included demographics, comorbidities, concomitant medications, biochemistry results including all blood potassium values, and all in-hospital prescribing. Factors associated with the need for insulin retreatment were explored using a mixed-effects logistic regression model and odds ratios are reported.


Insulin was administered to 1,284 adult patients(2,541 total administrations). Insulin-treated patients were aged 72 (IQR 59.5-84.5) years and had significant comorbidity (Charlson index 5, IQR 3 to 7). At the end of the follow-up period, only 60.3% remained alive. Potassium concentration immediately (≤ 60 min) pre-treatment was 6.34±1.2mmol/L. The mean reduction in potassium at 4-hours post infusion was 0.86±0.92mmol/L. Multiple doses were given to 542 patients (42.2%), of whom 209 (16.2%) were retreated within 4 hours of the first infusion. Patients receiving multiple insulin infusions were more likely to have chronic kidney disease (44.5% vs 36.5%,p=0.002) or heart failure (22.9% vs 17.4%,p=0.009) and to have been exposed to ACE inhibitors (33.2% vs 27.9%,p=0.02) or potassium sparing diuretics (19.4% vs 15.5%,p=0.04), although only CKD remained significantly associated with retreatment in a regression model adjusted for age, gender and co-morbidity (OR 1.4, 1.1-1.7,p=0.01). Dysregulation of glucose metabolism occurred in 672 patients (53%) following insulin. Hypoglycaemia (plasma glucose<4mmol/L) occurred in 133 patients (10.4%) within 4 hours of insulin administration, and 16 patients (1.2%) experienced a glucose < 2mmol/L.


HK requiring insulin treatment occurs most commonly in a more elderly and comorbid population, is associated with CKD, requires re-treatment in 4 out of 10 patients, and is associated with dysregulated glucose metabolism (either high or low) in 53%. There is an unmet need for improved emergency treatments for HK.


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