title: Hypoglycemia in the treatment of hyperkalemia with insulin in patients with end-stage renal disease.
abstract: BACKGROUND
  Hypoglycemia is common in patients with end-stage renal disease (ESRD). We identified the incidence and timing of hypoglycemia and its risk factors in hospitalized patients with ESRD after the treatment of hyperkalemia with insulin.
  
  
  METHODS
  We conducted a retrospective study of all hospitalized adult patients treated with hemodialysis who received intravenous insulin to treat hyperkalemia between 1 January 2011 and 31 December 2011. We identified patients who became hypoglycemic [blood glucose <3.3 mmol/L (60 mg/dL)] after insulin administration.
  
  
  RESULTS
  Two hundred and twenty-one episodes of hyperkalemia were treated with insulin, resulting in 29 episodes of hypoglycemia (13%). Factors associated with a higher risk of hypoglycemia included no prior diagnosis of diabetes [odds ratio (OR) 2.3, 95% confidence interval (CI) 1.0-5.1, P = 0.05], no use of diabetes medication prior to admission [OR 3.6, 95% CI 1.2-10.7, P = 0.02] and a lower pretreatment glucose level [mean 5.8 ± 0.7 mmol/L (104 ± 12 mg/dL) versus 9.0 ± 0.6 mmol/L (162 ± 11 mg/dL), P = 0.04]. Hypoglycemia occurred at a median of 2 h after insulin administration and persisted for a median of 2 h.
  
  
  CONCLUSIONS
  The treatment of hyperkalemia with insulin in hospitalized patients with ESRD may be complicated by hypoglycemia. Patients with a history of diabetes are less susceptible to this complication. Our study supports the use of a protocol to provide dextrose support and blood glucose monitoring for at least 3 h after insulin treatment of hyperkalemia.
authors: Section of Endocrinology, Department of Internal Medicine , Rush University Medical Center , Chicago, IL 60612 , USA.
authors: Jill
authors: J
authors: Apel
authors: Division of Endocrinology and Metabolism, Department of Medicine , Ramathibodi Hospital, Mahidol University , Bangkok 10400 , Thailand.
authors: Sirimon
authors: S
authors: Reutrakul
authors: Section of Endocrinology, Department of Internal Medicine , Rush University Medical Center , Chicago, IL 60612 , USA.
authors: David
authors: D
authors: Baldwin
keywords: end-stage renal disease; hyperkalemia; hypoglycemia; insulin