Purpose: To compare the effects of weight-based, reduced, and standard IV insulin doses on potassium reduction and hypoglycemia incidence in the treatment of acute hyperkalemia.
Methods: The hyperkalemia treatment order-set was updated to include reduced and weight-based insulin dose options. Patients ≥ 18 years old with acute hyperkalemia treated with insulin using the order-set were included. Patients with missing data or who started dialysis before follow-up potassium monitoring were excluded. The primary efficacy outcome was reduction in serum potassium. The primary safety outcome was incidence of hypoglycemia and severe hypoglycemia. Secondary outcomes included insulin dose administered, completion of hourly glucose checks, and dextrose use.
Results: The pre-protocol group included 60 patients and the post-protocol group included 76 patients. Potassium reduction was similar with a mean reduction of 0.9 mEq/L in the pre-protocol group and 0.85 mEq/L in the post-protocol group. The incidence of hypoglycemia was 18% in the pre-protocol group with 2% of patients developing severe hypoglycemia. The incidence of hypoglycemia was 13% in the post-protocol group with 3% of patients developing severe hypoglycemia. The mean insulin dose administered was 9.5 units in the pre-protocol group and 7.7 units in the post-protocol group. In the post-protocol group, weight-based and reduced insulin doses were administered to 84% and 13% of patients, respectively. Less than 25% of patients completed all glucose checks. Only about 50% of patients with hypoglycemia were treated with dextrose.
Conclusions: Using weight-based and reduced insulin doses in the treatment of acute hyperkalemia results in comparable potassium reduction and reduced hypoglycemia incidence.
Lioudis E, Ghoubrial-Waibel R, Kidd M. Impact of adding reduced and weight-based insulin dosing options to the emergency department and inpatient hyperkalemia order-set. Transformative Medicine (T-Med). 2023; 2(4):99-104. doi: https://doi.org/10.54299/tmed/odbj4693.