Bolus administration of intravenous glucose in the treatment of hyperkalemia: a randomized controlled trial.

Abstract

BACKGROUND:

Hyperkalemia is a common medical emergency that may result in serious cardiac arrhythmias. Standard therapy with insulin plus glucose reliably lowers the serum potassium concentration ([K(+)]) but carries the risk of hypoglycemia. This study examined whether an intravenous glucose-only bolus lowers serum [K(+)] in stable, nondiabetic, hyperkalemic patients and compared this intervention with insulin-plus-glucose therapy.

METHODS:

A randomized, crossover study was conducted in 10 chronic hemodialysis patients who were prone to hyperkalemia. Administration of 10 units of insulin with 100 ml of 50% glucose (50 g) was compared with the administration of 100 ml of 50% glucose only. Serum [K(+)] was measured up to 60 min. Patients were monitored for hypoglycemia and EKG changes.

RESULTS:

Baseline serum [K(+)] was 6.01 ± 0.87 and 6.23 ± 1.20 mmol/l in the insulin and glucose-only groups, respectively (p = 0.45). At 60 min, the glucose-only group had a fall in [K(+)] of 0.50 ± 0.31 mmol/l (p < 0.001). In the insulin group, there was a fall of 0.83 ± 0.53 mmol/l at 60 min (p < 0.001) and a lower serum [K(+)] at that time compared to the glucose-only group (5.18 ± 0.76 vs. 5.73 ± 1.12 mmol/l, respectively; p = 0.01). In the glucose-only group, the glucose area under the curve (AUC) was greater and the insulin AUC was smaller. Two patients in the insulin group developed hypoglycemia.

CONCLUSION:

Infusion of a glucose-only bolus caused a clinically significant decrease in serum [K(+)] without any episodes of hypoglycemia.

• Authors: Mogamat-Yazied Chothia, Mitchell L Halperin, Megan A Rensburg, Mogamat Shafick Hassan, Mogamat Razeen Davids
• Journal: Nephron. Physiology (Nephron Physiol) Vol. 126 Issue 1 Pg. 1-8 ( 2014) ISSN: 1660-2137 [Electronic] Switzerland
• PMID: 24576893 (Publication Type: Journal Article, Randomized Controlled Trial)
• Copyright: 2014 S. Karger AG, Basel.

Chemical References

• Insulin
• Glucose
• Potassium

Topics

• Administration, Intravenous
• Adult
• Cross-Over Studies
• Double-Blind Method
• Drug Therapy, Combination
• Female
• Glucose (administration & dosage, therapeutic use)
• Humans
• Hyperkalemia (complications, drug therapy)
• Insulin (administration & dosage, therapeutic use)
• Kidney Failure, Chronic (complications, therapy)
• Male
• Potassium (blood)
• Renal Dialysis (methods)
• Treatment Outcome