Publication: Hypoglycemia in the treatment of hyperkalemia with insulin in patients with end-stage renal disease
Issued Date
2014-01-01
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ISSN
20488513
20488505
20488505
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2-s2.0-84901940948
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Mahidol University
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SCOPUS
Bibliographic Citation
Clinical Kidney Journal. Vol.7, No.3 (2014), 248-250
Suggested Citation
Jill Apel, Sirimon Reutrakul, David Baldwin Hypoglycemia in the treatment of hyperkalemia with insulin in patients with end-stage renal disease. Clinical Kidney Journal. Vol.7, No.3 (2014), 248-250. doi:10.1093/ckj/sfu026 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/34681
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Title
Hypoglycemia in the treatment of hyperkalemia with insulin in patients with end-stage renal disease
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Abstract
BackgroundHypoglycemia is common in patients with end-stage renal disease (ESRD). We identified the incidence and timing of hypoglycemia and its risk factors in hospitalized patients with ESRD after the treatment of hyperkalemia with insulin.MethodsWe conducted a retrospective study of all hospitalized adult patients treated with hemodialysis who received intravenous insulin to treat hyperkalemia between 1 January 2011 and 31 December 2011. We identified patients who became hypoglycemic [blood glucose <3.3 mmol/L (60 mg/dL)] after insulin administration.ResultsTwo hundred and twenty-one episodes of hyperkalemia were treated with insulin, resulting in 29 episodes of hypoglycemia (13). Factors associated with a higher risk of hypoglycemia included no prior diagnosis of diabetes [odds ratio (OR) 2.3, 95 confidence interval (CI) 1.0-5.1, P 0.05], no use of diabetes medication prior to admission [OR 3.6, 95 CI 1.2-10.7, P 0.02] and a lower pretreatment glucose level [mean 5.8 ± 0.7 mmol/L (104 ± 12 mg/dL) versus 9.0 ± 0.6 mmol/L (162 ± 11 mg/dL), P 0.04]. Hypoglycemia occurred at a median of 2 h after insulin administration and persisted for a median of 2 h.ConclusionsThe treatment of hyperkalemia with insulin in hospitalized patients with ESRD may be complicated by hypoglycemia. Patients with a history of diabetes are less susceptible to this complication. Our study supports the use of a protocol to provide dextrose support and blood glucose monitoring for at least 3 h after insulin treatment of hyperkalemia. © 2014 The Author 2014.