The University of Tennessee Medical Center, Knoxville, TN, USA.
The University of Tennessee Graduate School of Medicine, Knoxville, TN, USA.
Am J Health Syst Pharm. 2022 Feb 18;79(Suppl 1):S13-S20. doi: 10.1093/ajhp/zxab382.
Hyperkalemia more commonly affects patients with a glomerular filtration rate of less than 60 mL/min. Using intravenous (IV) insulin to shift potassium intracellularly may cause hypoglycemia, requiring additional treatment or longer hospitalization. Literature on insulin dosing in this context is limited, with one previous study indicating that 5 units of IV insulin might be as effective and result in less hypoglycemia than the standard dose of 10 units of IV insulin. The hyperkalemia treatment pathway at our institution was revised in May 2018 to include a reduced-dose option (5 units of insulin) for patients with end-stage renal disease. This study aimed to compare the prevalence of hypoglycemia between patients who received standard-dose vs reduced-dose IV insulin.
This single-center, retrospective, quasi-experimental study evaluated the impact of revision of the hyperkalemia treatment pathway by assessing rates of hypoglycemia during the 6 months before and after implementation of the revised pathway. The primary endpoint was prevalence of hypoglycemia, defined as a blood glucose level of less than or equal to 70 mg/dL.
There was no statistically significant difference in the occurrence of hypoglycemia when comparing the pre- and postimplementation groups (36 [17.7%] patients vs 34 [18.7%] patients; P = 0.7924). The postimplementation group had a statistically significant lower reduction in potassium levels after treatment than the preimplementation group (mean [interquartile range], -0.9 [-1.3, -0.5] mEq/L vs -0.6 [-1.2, -0.2] mEq/L; P = 0.0095). Baseline potassium levels were similar between the groups.
Administration of reduced-dose IV insulin for treatment of hyperkalemia was significantly less effective in lowering serum potassium levels and did not decrease prevalence of hypoglycemia. When accounting for potential confounders, the only variable that was associated with hypoglycemia was pretreatment glucose level.
高钾血症更常影响肾小球滤过率低于 60ml/min 的患者。使用静脉内（IV）胰岛素将钾转移到细胞内可能导致低血糖，需要额外的治疗或更长时间的住院治疗。关于这种情况下胰岛素剂量的文献有限，以前的一项研究表明，5 单位的 IV 胰岛素可能与标准剂量的 10 单位 IV 胰岛素一样有效，且导致低血糖的可能性更小。我们机构的高钾血症治疗途径于 2018 年 5 月修订，包括为终末期肾病患者提供低剂量选择（5 单位胰岛素）。本研究旨在比较接受标准剂量与低剂量 IV 胰岛素的患者低血糖发生率。
这项单中心、回顾性、准实验研究通过评估实施修订后的高钾血症治疗途径前后 6 个月内低血糖的发生率，来评估高钾血症治疗途径修订的影响。主要终点是低血糖的发生率，定义为血糖水平低于或等于 70mg/dL。
在比较实施前后组时，低血糖的发生没有统计学上的显著差异（36[17.7%]例患者比 34[18.7%]例患者；P=0.7924）。与实施前组相比，实施后组治疗后血钾水平降低有统计学意义（平均[四分位间距]，-0.9[-1.3，-0.5]mEq/L 比-0.6[-1.2，-0.2]mEq/L；P=0.0095）。两组的基线血钾水平相似。
治疗高钾血症时使用低剂量 IV 胰岛素，降低血清钾水平的效果显著降低，且并未降低低血糖的发生率。在考虑潜在混杂因素时，与低血糖相关的唯一变量是治疗前血糖水平。
