A recent retrospective study examined the incidence of hypoglycemia for 1307 adult patient encounters with hyperkalemia (>5.3 mmol/L) over a five-year timeframe.
409 (31%) of patients were treated with IV insulin.
-31/409 (8%) experienced severe hypoglycemia (glucose < 50 mg/dL)
Patients with serum glucose <100mg/dL prior to insulin administration experienced even higher rates of hypoglycemia, 38/112 (34%).
Patients who did not receive IV insulin had a hypoglycemia rate of 4%.
In patients with critical illness, a single episode of hypoglycemia has been independently associated with increased mortality. Ensure patients receive adequate dextrose loading doses based on their pre-insulin blood glucose and monitor point of care glucose every 30-60 minutes for the first 3 hours of care. Use automated order sets when available.
Additional Information
References
Scott NL, Klein LR, Cales E, Driver BE. Hypoglycemia as a complication of intravenous insulin to treat hyperkalemia in the emergency department. Am J Emerg Med. 2019;37(2):209-213.
