title: Bolus administration of intravenous glucose in the treatment of hyperkalemia: a randomized controlled trial.
abstract: BACKGROUND
  Hyperkalemia is a common medical emergency that may result in serious cardiac arrhythmias. Standard therapy with insulin plus glucose reliably lowers the serum potassium concentration ([K(+)]) but carries the risk of hypoglycemia. This study examined whether an intravenous glucose-only bolus lowers serum [K(+)] in stable, nondiabetic, hyperkalemic patients and compared this intervention with insulin-plus-glucose therapy.
  
  
  METHODS
  A randomized, crossover study was conducted in 10 chronic hemodialysis patients who were prone to hyperkalemia. Administration of 10 units of insulin with 100 ml of 50% glucose (50 g) was compared with the administration of 100 ml of 50% glucose only. Serum [K(+)] was measured up to 60 min. Patients were monitored for hypoglycemia and EKG changes.
  
  
  RESULTS
  Baseline serum [K(+)] was 6.01 ± 0.87 and 6.23 ± 1.20 mmol/l in the insulin and glucose-only groups, respectively (p = 0.45). At 60 min, the glucose-only group had a fall in [K(+)] of 0.50 ± 0.31 mmol/l (p < 0.001). In the insulin group, there was a fall of 0.83 ± 0.53 mmol/l at 60 min (p < 0.001) and a lower serum [K(+)] at that time compared to the glucose-only group (5.18 ± 0.76 vs. 5.73 ± 1.12 mmol/l, respectively; p = 0.01). In the glucose-only group, the glucose area under the curve (AUC) was greater and the insulin AUC was smaller. Two patients in the insulin group developed hypoglycemia.
  
  
  CONCLUSIONS
  Infusion of a glucose-only bolus caused a clinically significant decrease in serum [K(+)] without any episodes of hypoglycemia.
authors.affiliation: Division of Nephrology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
authors.forename: Mogamat-Yazied
authors.initials: MY
authors.lastname: Chothia
authors.forename: Mitchell L
authors.initials: ML
authors.lastname: Halperin
authors.forename: Megan A
authors.initials: MA
authors.lastname: Rensburg
authors.forename: Mogamat Shafick
authors.initials: MS
authors.lastname: Hassan
authors.forename: Mogamat Razeen
authors.initials: MR
authors.lastname: Davids
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D018592:Cross-Over Studies; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D005947:Glucose / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D006947:Hyperkalemia / Q000150:complications* / Q000188:drug therapy*; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy*; D008297:Male; D011188:Potassium / Q000097:blood; D006435:Renal Dialysis / Q000379:methods; D016896:Treatment Outcome
chemical_list: D007328:Insulin; D005947:Glucose; D011188:Potassium