Hypoglycemia as a complication of intravenous insulin to treat hyperkalemia in the emergency department

• Published in: The American journal of emergency medicine 2019-02, Vol.37 (2), p.209-213
• Main Authors: Scott, Nathaniel L., Klein, Lauren R., Cales, Ellen, Driver, Brian E.
• Format: Article
• Language: English
• Subjects: Age; Diabetes; Diabetes mellitus; Diuretics; Drug dosages; Electronic medical records; Emergency department; Emergency management; Emergency medical care; Emergency medical services; Family medical history; Glucose; Hemodialysis; Hyperkalemia; Hypoglycemia; Illnesses; Insulin; Insulin resistance; Intravenous administration; Kidney diseases; Laboratories; Medical records; Multivariate analysis; Patients; Physicians; Potassium; Renal failure; Shifting; Sodium; Variables
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2018.05.016

Complications associated with the emergency department (ED) management of hyperkalemia are not well characterized. The goals of this study were to describe the frequency of hypoglycemia following the use of insulin to shift potassium intracellularly and to examine the association of key variables with this complication. Adult ED patients (≥18 years old) with hyperkalemia (>5.3 mmol/L) were identified in the electronic medical record over a 5-year period at the study site. Patient characteristics, laboratory results, and treatments in the ED were captured. A generalized estimating equation (GEE) model was utilized to determine independent associations with the development of hypoglycemia. 1307 encounters were identified where hyperkalemia was present. Hypoglycemia (defined as a glucose