Work

Hypoglycaemia and monitoring practices following insulin-dextrose therapy for hyperkalaemia

Year: 2025

Type: article

Abstract: Background Hypoglycaemia is commonly encountered following insulin-dextrose therapy (IDT) for hyperkalaemia . This retrospective study aimed to assess the local incidence of hypoglycaemia following IDT for hyperkalaemia in the Emergency Department (ED). Objectives Describe the local incidence of hypoglycaemia and BGL monitoring practices following IDT for hyperkalaemia in the ED. Methods Adult patients with hyperkalaemia (>5.5 mmol/L) who received IDT in a large metropolitan ED were included. The primary outcome was the incidence of hypoglycaemia, defined as a BGL less than 70 mg/dL (3.9 mmol/L), within 5 h post-administration. Secondary outcomes included hypoglycaemia severity, time to hypoglycaemia, risk factors for hypoglycaemia, blood glucose and potassium monitoring. Data collection spanned January 1, 2019 to May 1, 2020. Results Among 90 patients, 51 % were receiving chronic renal replacement therapies and the incidence of hypoglycaemia and severe hypoglycaemia was 30 % and 6.7 % respectively. Risk factors for hypoglycaemia were lower pre-treatment blood glucose (p=<0.001), absence of diabetes (p=<0.001) and not being prescribed insulin prior to presentation (p = 0.0026). Approximately 50 % of patients received ≤2 blood glucose measurements within 5 h post IDT. Only 44 % of patients had a potassium sample taken in the 1st hour post IDT and 24 % in hour 3. Conclusions This study demonstrates a higher incidence of hypoglycaemia post-IDT for hyperkalaemia than reported in the general population and estimates the incidence of severe hypoglycaemia in an Australian population. Monitoring of both blood glucose levels (BGL) and potassium was suboptimal. Strategies to improve BGL monitoring and prospective studies to define the optimal dose of insulin-glucose for hyperkalaemia are needed.

Source: JEM Reports

Authors: Samuel Ford, Julian Williams, Ian Coombes, Adam La Caze

Institutions: The University of Queensland, Royal Brisbane and Women's Hospital

Language: English

Topic: Potassium and Related Disorders

Subfield: Pulmonary and Respiratory Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $720

Funders: University of Queensland, Euratom Research and Training Programme