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Abstract: SA-OR47

Minimizing Hypoglycemia After Intravenous Insulin Regular Therapy for Hyperkalemia

Session Information

Category: Fluid, Electrolytes, and Acid-Base Disorders

  • 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical

Authors

  • Landry, Daniel L., Baystate Medical Center, Springfield, Massachusetts, United States
  • Duff, Emily, Baystate Medical Center, Springfield, Massachusetts, United States
  • Naglack, Erin, Baystate Medical Center, Springfield, Massachusetts, United States
Background

Intravenous (IV) insulin regular is utilized for the management of hyperkalemia. There is data demonstrating that weight-based (0.1 unit/kg) insulin results in less hypoglycemia while maintaining equivalent efficacy. The objective of this project was to evaluate if weight-based IV insulin regular dosing would minimize rates of hypoglycemia at our institution.

Methods

This single-center, pre-post design project included adult patients with hyperkalemia (potassium > 5 mEq/L) treated with IV insulin regular in the emergency department at a large tertiary care medical center. Historical management utilized fixed-dose 10 units of insulin regular (pre-intervention group). Exclusion criteria were patients who received insulin products for indications other than hyperkalemia, treated with hemodialysis, or received continuous dextrose fluids. The hyperkalemia order set was updated to 0.1 unit/kg IV insulin regular (maximum 10 units) and expanded point-of-care (POC) glucose monitoring from one hour to a total of four hours (post-intervention group). The primary outcomes were rates of hypoglycemia (blood glucose < 70 mg/dL) and severe hypoglycemia (blood glucose < 50 mg/dL). Secondary outcomes were reduction in potassium levels, administration of additional potassium lowering agents, and compliance to weight-based dosing and expanded POC monitoring.

Results

A total of 68 patients were included in the pre-intervention group and 58 patients in the post-intervention group. Hypoglycemia was more frequent in the pre-intervention group compared to the post-intervention group (26.5% versus 17.2%). Similar results were seen with severe hypoglycemia (7.3% versus 1.7%). The median reduction in potassium levels in the pre-intervention group was 0.95 mEq/L and 0.85 mEq/L in the post-intervention group. For patients who received insulin regular only and with no concomitant potassium lowering agent, the median reduction in potassium in the pre-intervention group was 0.7 mEq/L (IQR 0.5-1.55) compared to 0.85 mEq/L (0.35-1.33). There was 36.2% compliance with weight-based insulin regular dosing and 0% compliance with the extended POC monitoring schedule in the post-intervention group.

Conclusion

This project found that using weight-based insulin regular dosing may lead to a reduction in hypoglycemia, especially severe hypoglycemia, without needing additional potassium lowering agents.