Pierce Dwayne A, Russell Greg, Pirkle James L
Georgia Regents University Medical Center, Augusta, GA, USA
Wake Forest University School of Medicine, Winston-Salem, NC, USA.
Ann Pharmacother. 2015 Dec;49(12):1322-6. doi: 10.1177/1060028015607559. Epub 2015 Sep 28.
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.
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.
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.
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).
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.
高钾血症是一种可能危及生命的疾病，在肾病患者中很常见。胰岛素用于治疗高钾血症，但可能会导致低血糖，尤其是在肾病患者中，因为胰岛素的代谢可能会更慢。
我们比较了估算肾小球滤过率（eGFR）低的患者使用高剂量与低剂量胰岛素治疗高钾血症时的低血糖发生率，以确定较低剂量的胰岛素是否会降低低血糖的发生率。
这是一项对6个月内接受静脉注射胰岛素治疗高钾血症的住院患者的回顾性研究。根据估算肾小球滤过率低的患者接受胰岛素的剂量对其进行分析：高剂量组（10单位，n = 78）和低剂量组（5单位，n = 71）。在给药后长达8小时内检查给药后的最低血糖值。然后报告每个剂量组的低血糖发生率（血糖≤70mg/dl）和严重低血糖的一个子集（血糖<50mg/dl）。
在估算肾小球滤过率低的患者中总共确定了149次给药。高剂量组（n = 78）和低剂量组（n = 71）的低血糖发生率分别为16.7%和19.7%（P = 0.79）。严重低血糖发生率分别为8.9%和7.0%（P = 0.90）。高剂量组超过28%的低血糖发作发生在4小时后（中位数 = 2.5小时），而低剂量组为14.3%（中位数 = 2.38小时）。
估算肾小球滤过率低的患者使用高剂量或低剂量胰岛素时，低血糖或严重低血糖的发生率没有差异。我们建议在高钾血症患者使用胰岛素后监测长达6小时。
