CHSU Discovery

Abstract

Hyperkalemia may result in life threatening cardiac arrhythmias if not appropriately treated.
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Standard of care includes administering IV regular insulin to transiently shift K intracellularly.
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IV regular insulin use is limited by its propensity to cause hypoglycemia in up to 75% of patients.
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Patients with impaired renal clearance and lower pre insulin glucose values are more likely to develop hypoglycemia.
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Administering dextrose concomitantly with insulin, reducing the insulin dose, and utilizing order sets reduces hypoglycemic rates, but does not eliminate them.
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Hypoglycemia commonly occurs 60 minutes after insulin administration and may persist for up to two hours post insulin administration, suggesting current protocols which include the administration of a single dextrose 50% dose (50 mL) concomitantly with insulin are inadequate.
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In December 2022, the Community Medical Centers adult acute hyperkalemia management order set was revised to reduce hypoglycemic events (Table 1).
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Study Purpose: determine if the new adult acute hyperkalemia order set reduced hypoglycemic rates in patients with impaired renal clearance and lower pre insulin glucose values