Incidence of Hypoglycemia in Patients With Low eGFR Treated With Insulin and Dextrose for Hyperkalemia

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...

Full description

Saved in:
Bibliographic Details
Published inThe Annals of pharmacotherapy Vol. 49; no. 12; p. 1322
Main Authors Pierce, Dwayne A, Russell, Greg, Pirkle, Jr, James L
Format Journal Article
LanguageEnglish
Published United States 01.12.2015
Subjects
Online AccessGet more information

Cover

Loading…
Abstract 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.
AbstractList 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.
Author Pirkle, Jr, James L
Pierce, Dwayne A
Russell, Greg
Author_xml – sequence: 1
  givenname: Dwayne A
  surname: Pierce
  fullname: Pierce, Dwayne A
  email: dwpierce@gru.edu
  organization: Georgia Regents University Medical Center, Augusta, GA, USA dwpierce@gru.edu
– sequence: 2
  givenname: Greg
  surname: Russell
  fullname: Russell, Greg
  organization: Wake Forest University School of Medicine, Winston-Salem, NC, USA
– sequence: 3
  givenname: James L
  surname: Pirkle, Jr
  fullname: Pirkle, Jr, James L
  organization: Wake Forest University School of Medicine, Winston-Salem, NC, USA
BackLink https://www.ncbi.nlm.nih.gov/pubmed/26416951$$D View this record in MEDLINE/PubMed
BookMark eNo1j11LwzAYRoMo7kPvvZL8geqbtGmSS5luKxQUmXg50uatVtt0NBmu_96O6dWBh4cDZ0bOXeeQkBsGd4xJec8gBeAKmEhBCqHPyJSJhEcplzAhM--_AEAzri_JhKcJS7VgU1JlrqwtuhJpV9H1sOs-mqHEtja0dvTFhBpd8PS9Dp80734orpavdNOjCWhPa-b8vhm_xln6iIfQdx5p1fVHGfbfpjnKrshFZRqP13-ck7fl02axjvLnVbZ4yKMylhAiUQiZKEwSFGxMsQKqWBmlmY0t1zyO1UjLC2tUMtZYzXWs1BhoVSmlQT4ntyfvbl-0aLe7vm5NP2z_g_kvKhFW3A
CitedBy_id crossref_primary_10_1097_CCE_0000000000000092
crossref_primary_10_1371_journal_pone_0268395
crossref_primary_10_1016_j_ajem_2019_158374
crossref_primary_10_1016_j_resuscitation_2021_02_011
crossref_primary_10_1371_journal_pone_0172961
crossref_primary_10_1111_acem_13868
crossref_primary_10_1111_ijcp_13052
crossref_primary_10_1016_j_jemermed_2019_03_043
crossref_primary_10_1136_bmjopen_2022_071311
crossref_primary_10_1111_ijn_13080
crossref_primary_10_1093_ajhp_zxab382
crossref_primary_10_1177_0018578718779012
crossref_primary_10_1016_j_jen_2022_09_009
crossref_primary_10_1016_j_jtumed_2021_07_014
crossref_primary_10_1016_j_eprac_2022_08_002
crossref_primary_10_1136_emermed_2019_208744
crossref_primary_10_1016_j_ajem_2019_09_003
crossref_primary_10_4103_tjem_tjem_288_22
crossref_primary_10_1016_j_ekir_2017_10_009
crossref_primary_10_1007_s10049_021_00891_z
crossref_primary_10_1016_j_trre_2021_100611
crossref_primary_10_1097_TME_0000000000000504
crossref_primary_10_1038_s41598_020_79180_7
crossref_primary_10_1002_phar_2038
crossref_primary_10_1177_2042098618768725
crossref_primary_10_1002_phar_2596
crossref_primary_10_1016_j_clinme_2024_100222
crossref_primary_10_1093_eurheartj_suy029
crossref_primary_10_1111_acem_13954
crossref_primary_10_1177_0897190018799220
crossref_primary_10_1016_j_ejim_2021_09_018
crossref_primary_10_1002_emp2_12572
crossref_primary_10_1016_j_jemermed_2018_09_007
crossref_primary_10_1016_j_jemermed_2018_12_030
ContentType Journal Article
Copyright The Author(s) 2015.
Copyright_xml – notice: The Author(s) 2015.
DBID CGR
CUY
CVF
ECM
EIF
NPM
DOI 10.1177/1060028015607559
DatabaseName Medline
MEDLINE
MEDLINE (Ovid)
MEDLINE
MEDLINE
PubMed
DatabaseTitle MEDLINE
Medline Complete
MEDLINE with Full Text
PubMed
MEDLINE (Ovid)
DatabaseTitleList MEDLINE
Database_xml – sequence: 1
  dbid: NPM
  name: PubMed
  url: https://proxy.k.utb.cz/login?url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed
  sourceTypes: Index Database
– sequence: 2
  dbid: EIF
  name: MEDLINE
  url: https://proxy.k.utb.cz/login?url=https://www.webofscience.com/wos/medline/basic-search
  sourceTypes: Index Database
DeliveryMethod no_fulltext_linktorsrc
Discipline Pharmacy, Therapeutics, & Pharmacology
EISSN 1542-6270
ExternalDocumentID 26416951
Genre Journal Article
GroupedDBID ---
-TM
.GJ
01A
0R~
0VX
1CY
23M
39C
4.4
53G
54M
5GY
5RE
6J9
6PF
AABMB
AACKU
AACMV
AACTG
AADTT
AADUE
AAEWN
AAGGD
AAGMC
AAJIQ
AAJOX
AAJPV
AAKGS
AAMGE
AANSI
AAPEO
AAQQT
AAQXH
AARDL
AARIX
AATAA
AATBZ
AAUAS
AAWTL
AAXOT
AAYOK
AAYTG
AAZBJ
ABAWP
ABCCA
ABDWY
ABEIX
ABFWQ
ABHKI
ABJIS
ABJNI
ABKRH
ABLUO
ABOCM
ABPGX
ABPNF
ABQKF
ABQXT
ABRHV
ABVFX
ABVVC
ABYTW
ACARO
ACDSZ
ACDXX
ACFEJ
ACFMA
ACFYK
ACGBL
ACGFO
ACGFS
ACGZU
ACJER
ACJTF
ACLFY
ACLHI
ACLZU
ACOFE
ACOXC
ACROE
ACSBE
ACSIQ
ACTQU
ACUAV
ACUIR
ACXKE
ACXMB
ADBBV
ADEIA
ADMPF
ADNBR
ADRRZ
ADTBJ
ADUKL
ADZZY
AECGH
AECVZ
AEDTQ
AEKYL
AENEX
AEPTA
AEQLS
AERKM
AESZF
AEUHG
AEUIJ
AEWDL
AEWHI
AEXFG
AEXNY
AFEET
AFFNX
AFKBI
AFKRG
AFMOU
AFQAA
AFUIA
AGKLV
AGNHF
AGWFA
AHJOV
AIGRN
AIIQI
AIOMO
AIZAD
AJABX
AJEFB
AJMMQ
AJSCY
AJUZI
AJXAJ
ALKWR
ALMA_UNASSIGNED_HOLDINGS
ALTZF
AMCVQ
ANDLU
ARTOV
AUTPY
AUVAJ
AYAKG
B8M
BBRGL
BDDNI
BKIIM
BKSCU
BPACV
BSEHC
BWJAD
CBRKF
CDWPY
CFDXU
CGR
CORYS
CQQTX
CS3
CUTAK
CUY
CVF
DB0
DC-
DC.
DC0
DD-
DD0
DE-
DE.
DF0
DN0
DO-
DOPDO
DV7
EBS
ECM
EIF
EJD
EMOBN
F5P
FHBDP
GROUPED_SAGE_PREMIER_JOURNAL_COLLECTION
H13
HZ~
J5H
J8X
JCYGO
K.F
L7B
LSO
M4V
NPM
O9-
P.9
P.B
P2P
Q1R
ROL
S01
SCNPE
SFC
SHG
SJN
SPQ
SPV
THW
UDS
WH7
YCJ
ZGI
ZONMY
ZPPRI
ZRKOI
ZSSAH
ZXP
ID FETCH-LOGICAL-c370t-5b5748e44e51280d50f38a891d3d2923383d2d2bda84000d929388270d8c77ae2
IngestDate Sat Sep 28 07:58:06 EDT 2024
IsPeerReviewed true
IsScholarly true
Issue 12
Keywords insulin
hyperkalemia
hypoglycemia
low eGFR
Language English
License The Author(s) 2015.
LinkModel OpenURL
MergedId FETCHMERGED-LOGICAL-c370t-5b5748e44e51280d50f38a891d3d2923383d2d2bda84000d929388270d8c77ae2
PMID 26416951
ParticipantIDs pubmed_primary_26416951
PublicationCentury 2000
PublicationDate 2015-Dec
PublicationDateYYYYMMDD 2015-12-01
PublicationDate_xml – month: 12
  year: 2015
  text: 2015-Dec
PublicationDecade 2010
PublicationPlace United States
PublicationPlace_xml – name: United States
PublicationTitle The Annals of pharmacotherapy
PublicationTitleAlternate Ann Pharmacother
PublicationYear 2015
SSID ssj0009129
Score 2.358548
Snippet Hyperkalemia is a potentially life-threatening condition that is common in kidney disease patients. Insulin is used to treat hyperkalemia, but may cause...
SourceID pubmed
SourceType Index Database
StartPage 1322
SubjectTerms Administration, Intravenous
Adult
Aged
Blood Glucose - metabolism
Female
Glomerular Filtration Rate
Glucose - adverse effects
Humans
Hyperkalemia - drug therapy
Hyperkalemia - physiopathology
Hypoglycemia - chemically induced
Incidence
Insulin - adverse effects
Kidney Failure, Chronic - physiopathology
Male
Middle Aged
Retrospective Studies
Title Incidence of Hypoglycemia in Patients With Low eGFR Treated With Insulin and Dextrose for Hyperkalemia
URI https://www.ncbi.nlm.nih.gov/pubmed/26416951
Volume 49
hasFullText
inHoldings 1
isFullTextHit
isPrint
link http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV1LbxMxELZSuHBBUN6Pag6ol3TB2bVj54gQpVRQRVUq9VbZay-NSh5KtirLsb-848c-iAoCLpvI1q6inS_2N56Zbwh5Y3HfKZTiCUtzljCts0RpXSSUS6qFI6y-S8TXo-HBCTs85ae93nUna-my1G_zn7fWlfyPVXEM7eqqZP_Bss1DcQC_o33xihbG61_ZGP_coSeoP46vlotv36vczqbKnWKMg2KqS3Atz_tfFld9-2n_uD9xLBFZph_9HDPRQz7yj3Llstdd4iE-zK4ucPOYTVWXv_oezo3m8jLqXpe_ShOMpy5bxq9mV6pCFtug5PhyvY6BDlcc096wughpzYerJnU31kPEE4kB72R32LiKsjQZpqEjSL3MBmXSGk5pZ9F0DvHtq7mPJ6PT6gPAruZb8KAf3jHucuati8RuMBwF8do_z27oa9dTW2RLSNf848id99SyzUiH2uD2u82f4qSk4-0bbomnJ5MH5H70K-B9AMlD0rPzbbI7Dgaq9mDS1tmt92AXxq1kefWIFA2SYFFAF0kwnUONJHCYAUQSOCRBRFIYjUgCRBLUSAJEEnSR9Jic7H-cfDhIYgeOJM8ELROuuWDSMmaRF0pqOC0yqeRoYDKTomuQSfw0qTZK4l5ADXLtDF02QY3MhVA2fULuzBdz-4yAyXhmlR4i3XfB5kLLdKQstZIKkzMlnpOn4f2dLYPMyln9Zl_8duYludfi7xW5WyD67WskiaXe8Xa8AS-YZPM
link.rule.ids 780
linkProvider National Library of Medicine
openUrl ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Incidence+of+Hypoglycemia+in+Patients+With+Low+eGFR+Treated+With+Insulin+and+Dextrose+for+Hyperkalemia&rft.jtitle=The+Annals+of+pharmacotherapy&rft.au=Pierce%2C+Dwayne+A&rft.au=Russell%2C+Greg&rft.au=Pirkle%2C+Jr%2C+James+L&rft.date=2015-12-01&rft.eissn=1542-6270&rft.volume=49&rft.issue=12&rft.spage=1322&rft_id=info:doi/10.1177%2F1060028015607559&rft_id=info%3Apmid%2F26416951&rft_id=info%3Apmid%2F26416951&rft.externalDocID=26416951