title: Hypoglycemia following intravenous insulin plus glucose for hyperkalemia in patients with impaired renal function.
abstract: BACKGROUND
  Hypoglycemia is a serious complication following the administration of insulin for hyperkalemia. We determined the incidence of hypoglycemia and severe hypoglycemia (blood glucose <70 or ≤40 mg/dl, respectively) in a cohort of AKI and non-dialysis dependent CKD patients who received an intravenous infusion of insulin plus glucose to treat hyperkalemia.
  
  
  METHODS
  We retrospectively reviewed charts of all AKI and non-dialysis dependent CKD patients who received 10 U of insulin plus 50 g glucose to treat hyperkalemia from December 1, 2013 to May 31, 2015 at our Department.
  
  
  RESULTS
  One hundred sixty four episodes of hyperkalemia were treated with insulin plus glucose and were eligible for analysis. Serum potassium levels dropped by 1.18 ± 1.01 mmol/l. Eleven treatments (6.1%) resulted in hypoglycemia and two (1.2%) in severe hypoglycemia. A lower pretreatment blood glucose tended to associate with a higher subsequent risk of hypoglycemia. Age, sex, renal function, an established diagnosis of diabetes or previous treatment were not associated with the development of this complication. We did not register any significant adverse events.
  
  
  CONCLUSIONS
  Our intravenous regimen combining an infusion of insulin plus glucose effectively reduced serum potassium levels compared to previous studies and associated a low risk of symptomatic hypoglycemia and other complications.
authors.affiliation: Department of Nephrology, Hospital Clínico Universitario, Valladolid, Spain.
authors.forename: Armando
authors.identifier: http://orcid.org/0000-0002-1724-5229
authors.initials: A
authors.lastname: Coca
authors.affiliation: Department of Nephrology, Hospital Clínico Universitario, Valladolid, Spain.
authors.forename: Ana Lucia
authors.initials: AL
authors.lastname: Valencia
authors.affiliation: Department of Medicine, Dermatology and Toxicology, School of Medicine, University of Valladolid, Valladolid, Spain.
authors.forename: Jesus
authors.initials: J
authors.lastname: Bustamante
authors.affiliation: Department of Nephrology, Hospital Clínico Universitario, Valladolid, Spain.|Department of Medicine, Dermatology and Toxicology, School of Medicine, University of Valladolid, Valladolid, Spain.
authors.forename: Alicia
authors.initials: A
authors.lastname: Mendiluce
authors.affiliation: Department of Nephrology, RWTH University of Aachen, Aachen, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Floege
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000187:drug effects; D005260:Female; D005947:Glucose / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D006947:Hyperkalemia / Q000097:blood / Q000188:drug therapy*; D007003:Hypoglycemia / Q000097:blood / Q000188:drug therapy*; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D007668:Kidney / Q000187:drug effects / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011188:Potassium / Q000097:blood; D006435:Renal Dialysis; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose; D007328:Insulin; D005947:Glucose; D011188:Potassium