Insulin/dextrose only transiently effective for hyperkalemia management, study finds
UK: A recent study in the European Journal of Internal Medicine has provided novel insight into the emergency management of hyperkalemia. It demonstrates the high risk of hypoglycemia, prolonged length of hospital stay related to Insulin/dextrose (IDex) treatment, and increased risk of ICU admission highlighting the urgent need for an improved, evidence-based approach to the emergency management of hyperkalemia.
Hyperkalaemia is a common, life-threatening electrolyte abnormality that occurs in up to 10% of hospital admissions. The condition if not treated promptly can result in fatal cardiac arrhythmias. It typically requires in-hospital treatment and constitutes a medical emergency. Despite the high prevalence of hyperkalemia, its treatment in the emergency setting is inconsistent. An insulin and dextrose combination is the recommended first-line treatment for lowering potassium in the emergency setting.
Against the above background, Toby J.L. Humphrey, University of Cambridge, Cambridge, United Kingdom, and colleagues aimed to describe the emergency management of hyperkalemia in adults with insulin-dextrose (IDex) and to explore clinical outcomes associated with IDex treatment.
Working towards their aim, they conducted a cohort study using comprehensive electronic health records of all emergency admissions to a large university hospital in the United Kingdom between April 2015 and August 2018. It included adult patients aged ≥16 years with at least one emergency admission and one blood potassium result during the study period.
Emergency hyperkalemia treatment was evaluated including the requirement for re-treatment with IDex, episodes of glucose dysregulation, intensive care (ICU) admission, and length of hospital stay.
The researchers identified 11,107 hyperkalaemic adult patients, of whom 1,284 were treated with IDex.
Based on the study, the researchers found the following:
- Multiple doses were required in 42.2% of the patients.
- Hypoglycemia (plasma glucose < 4 mmol/L) occurred in 19.4% of the patients within 6 hours of IDex.
- Repeated doses were associated with an increased risk of hypoglycemia (OR 2.94) compared to patients receiving a single dose, which, after adjustment was also associated with an increased risk of death (OR 1.56) during the study period.
- Patients who received multiple doses of IDex (OR 2.2) and those who received a dose of insulin above the guideline-recommended limit (OR 5.6) were more likely to be admitted to ICU following IDex than those who received a single dose or the guideline-recommended dose of insulin.
"Further studies are needed to determine the safest and most effective dosing strategies for IDex and robust trials of emerging treatment strategies such as oral potassium binders in the emergency setting with clinically meaningful endpoints," concluded the authors.
Reference:
The study titled, "Clinical outcomes associated with the emergency treatment of hyperkalaemia with intravenous insulin-dextrose," is published in the European Journal of Internal Medicine.
DOI: https://www.ejinme.com/article/S0953-6205(21)00327-7/fulltext
