Impact of dextrose dose on hypoglycemia development following treatment of hyperkalemia.

Background: Hyperkalemia is an electrolyte abnormality that may cause ventricular dysrhythmias and cardiac arrest. The presence of hyperkalemia may necessitate prompt treatment via intravenous insulin and dextrose. One notable complication of this therapy is the development of hypoglycemia. Previous trials have examined the impact of altering the insulin dose administered on hypoglycemia development; no trials to date however, have examined the impact of altering the dextrose dose.

Methods: This was a multicenter, retrospective, matched cohort study of patients who received intravenous insulin and dextrose for reversal of hyperkalemia. Patients received either 25 g or 50 g of dextrose in addition to 10 units of insulin. Study populations were matched based on preexisting rates of acute kidney injury, end-stage renal disease, and diabetes mellitus. Blood glucose levels were measured at 60 and 240 min following treatment.

Results: A total of 240 patients were included in the analysis. At 60 min following treatment, 15.8% of patients who received 25 g of dextrose developed hypoglycemia, as opposed to 8.3% of patients who received 50 g of dextrose ( p = 0.11). Hyperglycemia was more common in patients who received 50 g of dextrose at 60 min posttreatment; however, this difference did not persist at 240 min. Potassium reduction at 60 min did not differ between groups. In patients with a pretreatment blood glucose <110 mg/dl or without diabetes, rates of hypoglycemia were significantly lower when 50 g of dextrose was administered.

Conclusion: In the overall patient population, use of 50 g of dextrose instead of 25 g does not reduce hypoglycemia incidence. However, it may be beneficial is select patient populations, such as patients without type 2 diabetes or patients with a baseline blood glucose <110 mg/dl. Administration of 50 g of dextrose did not appear to place patients at significant risk for hyperglycemia however and could be considered during treatment of hyperkalemia.