Comparison of IV Insulin Dosing Strategies for Hyperkalemia in the Emergency Department

Abstract

Objectives: The objectives of this study were to evaluate the safety and efficacy of insulin dosing of less than 10 units versus 10 units in patients receiving hyperkalemia treatment. Design: Retrospective single-center study. Setting: Emergency department at a large academic medical center in the United States. Patients: Seven hundred adults treated for hyperkalemia with IV regular insulin between April 1, 2013, and September 27, 2018. Interventions: Patients that received less than 10 units of insulin were compared to those that received 10 units of insulin. Measurements and Main Results: Patients treated with less than 10 units had significantly lower frequency of hypoglycemia (11.2% vs 17.6%; p = 0.008). Reduction in serum potassium was significantly more modest in size in patients treated with less than 10 units (mean reduction 0.94 ± 0.71 mMol/L) compared with patients treated with 10 units (mean reduction 1.11 ± 0.8 mMol/L; p = 0.008). There were no statistically significant differences between groups in time to hypoglycemia, nadir serum glucose, severe hypoglycemia (<40 mg/dL), dextrose requirements, use of concurrent agents for hyperkalemia, need for repeat insulin dosing, length of stay, or mortality. Conclusions: Patients treated for hyperkalemia with insulin doses less than 10 units had reduced frequency of hypoglycemia; however, potassium reduction post treatment was more modest in these patients. These findings suggest providers choosing to administer 10 units IV insulin should ensure patients have adequate monitoring for hypoglycemia.