Aim: Moderate to severe hyperkalaemia is a common problem for hospital inpatients which requires treatment with Insulin and Dextrose. We identified the incidence of hypoglycaemia related to this treatment, timing of glucose nadir and associated risk factors.
Methods: We conducted a retrospective, multi-site cohort study of all hospitalized adult patients with hyperkalaemia (serum potassium ≥ 6mmol/l) treated with intravenous insulin-dextrose from 1st January 2019 to 1st March 2020.
Results: A final number of patients included in the analysis was 421. The change in serum potassium post-treatment was 1.4 mmol/L (standard deviation,0.8 mmol/L) lower than pre-treatment and the degree of potassium lowering was not different based on hypoglycaemia status. The incidence of hypoglycaemia was 21.4%. Independently associated risk factors are identified from a multivariable logistic regression analysis. Risk factors associated with a higher risk of hypoglycaemia are eGFR < 60 ml/min/1.73m2 and location of treatment in the Emergency Department. Higher body mass index and pre-treatment glucose are associated with lower odds of hypoglycaemia. Most hypoglycaemia occurred in the second hour of treatment and peaked at around 90 minutes.
Conclusion: Our hospital’s protocol for management of moderate to severe hyperkalaemia with insulin dextrose carries a significant risk of hypoglycaemia (21.4%). Our study supports the use of the current protocol to provide blood glucose monitoring for 6 h after a single insulin dextrose treatment. Patients with a higher body mass index and higher pre-treatment of blood glucose are at a lesser risk of hypoglycaemia unlike patients with chronic kidney disease (eGFR < 60 ml/min/1.73m2) who are at a higher risk. Further work is needed to understand the reasons behind why the Emergency Department appears to be a higher risk area for hypoglycaemia post insulin dextrose treatment.