title: Incidence of Hypoglycemia in Patients With Low eGFR Treated With Insulin and Dextrose for Hyperkalemia.
abstract: BACKGROUND
  Hyperkalemia is a potentially life-threatening condition that is common in kidney disease patients. Insulin is used to treat hyperkalemia, but may cause hypoglycemia, especially in kidney disease when insulin may be metabolized more slowly.
  
  
  OBJECTIVE
  We compared the rates of hypoglycemia in patients with low estimated glomerular filtration rate (eGFR) using high versus low doses of insulin for hyperkalemia to determine if lower doses of insulin would decrease the incidence of hypoglycemia.
  
  
  METHODS
  This was a retrospective study of hospitalized patients receiving intravenous insulin for hyperkalemia during a 6-month period. Patients with low eGFR were analyzed based on how much insulin they received: high dose (10 units, n = 78) versus low dose (5 units, n = 71). Postdose nadir blood glucose values were examined for up to 8 hours after the dose. The percentage of hypoglycemia (blood glucose ≤70 mg/dl) and a subset of severe hypoglycemia (blood glucose <50 mg/dl) were then reported for each dose group.
  
  
  RESULTS
  A total of 149 doses were identified in patients with low eGFR. The rates of hypoglycemia were 16.7% and 19.7% (P = 0.79), respectively, among high-dose (n = 78) and low-dose (n = 71) groups. Rates of severe hypoglycemia were 8.9% and 7.0%, respectively (P = 0.90). More than 28% of hypoglycemic episodes with high doses occurred after 4 hours (median = 2.5 hours) compared with 14.3% with low doses (median = 2.38 hours).
  
  
  CONCLUSIONS
  There was no difference in the rate of hypoglycemia or severe hypoglycemia between high or low doses of insulin in patients with low eGFR. We recommend monitoring up to 6 hours after insulin use in hyperkalemia.
authors.affiliation: Georgia Regents University Medical Center, Augusta, GA, USA dwpierce@gru.edu.
authors.forename: Dwayne A
authors.initials: DA
authors.lastname: Pierce
authors.affiliation: Wake Forest University School of Medicine, Winston-Salem, NC, USA.
authors.forename: Greg
authors.initials: G
authors.lastname: Russell
authors.affiliation: Wake Forest University School of Medicine, Winston-Salem, NC, USA.
authors.forename: James L
authors.initials: JL
authors.lastname: Pirkle
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D005260:Female; D005919:Glomerular Filtration Rate; D005947:Glucose / Q000009:adverse effects*; D006801:Humans; D006947:Hyperkalemia / Q000188:drug therapy* / Q000503:physiopathology; D007003:Hypoglycemia / Q000139:chemically induced*; D015994:Incidence; D007328:Insulin / Q000009:adverse effects*; D007676:Kidney Failure, Chronic / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose; D007328:Insulin; D005947:Glucose
keywords: hyperkalemia; hypoglycemia; insulin; low eGFR