Hypoglycaemia and monitoring practices following insulin-dextrose therapy for hyperkalaemia
Background: Hypoglycaemia is commonly encountered following insulin-dextrose therapy (IDT) for hyperkalaemia. This retrospective study aimed to assess the local incidence of hypoglycaemia following IDT for hyperkalaemia in the Emergency Department (ED). Objectives: Describe the local incidence of hy...
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Elsevier
2025-03-01
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2773232025000069 |
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| author | Samuel Ford Julian Williams Ian Coombes Adam La Caze |
| author_facet | Samuel Ford Julian Williams Ian Coombes Adam La Caze |
| author_sort | Samuel Ford |
| collection | DOAJ |
| description | Background: Hypoglycaemia is commonly encountered following insulin-dextrose therapy (IDT) for hyperkalaemia. This retrospective study aimed to assess the local incidence of hypoglycaemia following IDT for hyperkalaemia in the Emergency Department (ED). Objectives: Describe the local incidence of hypoglycaemia and BGL monitoring practices following IDT for hyperkalaemia in the ED. Methods: Adult patients with hyperkalaemia (>5.5 mmol/L) who received IDT in a large metropolitan ED were included. The primary outcome was the incidence of hypoglycaemia, defined as a BGL less than 70 mg/dL (3.9 mmol/L), within 5 h post-administration. Secondary outcomes included hypoglycaemia severity, time to hypoglycaemia, risk factors for hypoglycaemia, blood glucose and potassium monitoring. Data collection spanned January 1, 2019 to May 1, 2020. Results: Among 90 patients, 51 % were receiving chronic renal replacement therapies and the incidence of hypoglycaemia and severe hypoglycaemia was 30 % and 6.7 % respectively. Risk factors for hypoglycaemia were lower pre-treatment blood glucose (p=<0.001), absence of diabetes (p=<0.001) and not being prescribed insulin prior to presentation (p = 0.0026). Approximately 50 % of patients received ≤2 blood glucose measurements within 5 h post IDT. Only 44 % of patients had a potassium sample taken in the 1st hour post IDT and 24 % in hour 3. Conclusions: This study demonstrates a higher incidence of hypoglycaemia post-IDT for hyperkalaemia than reported in the general population and estimates the incidence of severe hypoglycaemia in an Australian population. Monitoring of both blood glucose levels (BGL) and potassium was suboptimal. Strategies to improve BGL monitoring and prospective studies to define the optimal dose of insulin-glucose for hyperkalaemia are needed. |
| format | Article |
| id | doaj-art-6003c5e0dc3241389899fd1641981f63 |
| institution | Kabale University |
| issn | 2773-2320 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JEM Reports |
| spelling | doaj-art-6003c5e0dc3241389899fd1641981f632025-02-02T05:29:37ZengElsevierJEM Reports2773-23202025-03-0141100142Hypoglycaemia and monitoring practices following insulin-dextrose therapy for hyperkalaemiaSamuel Ford0Julian Williams1Ian Coombes2Adam La Caze3The University of Queensland, Faculty of Health and Behavioural Sciences, Brisbane, Australia; Royal Brisbane and Women's Hospital, Pharmacy Department, Brisbane, Australia; Royal Brisbane and Women's Hospital, Emergency and Trauma Centre, Brisbane, Australia; Corresponding author. Royal Brisbane and Women's Hospital, Pharmacy Department, Brisbane, Australia.The University of Queensland, Faculty of Medicine, Brisbane, Australia; Royal Brisbane and Women's Hospital, Emergency and Trauma Centre, Brisbane, AustraliaThe University of Queensland, Faculty of Health and Behavioural Sciences, Brisbane, Australia; Royal Brisbane and Women's Hospital, Pharmacy Department, Brisbane, AustraliaThe University of Queensland, Faculty of Health and Behavioural Sciences, Brisbane, AustraliaBackground: Hypoglycaemia is commonly encountered following insulin-dextrose therapy (IDT) for hyperkalaemia. This retrospective study aimed to assess the local incidence of hypoglycaemia following IDT for hyperkalaemia in the Emergency Department (ED). Objectives: Describe the local incidence of hypoglycaemia and BGL monitoring practices following IDT for hyperkalaemia in the ED. Methods: Adult patients with hyperkalaemia (>5.5 mmol/L) who received IDT in a large metropolitan ED were included. The primary outcome was the incidence of hypoglycaemia, defined as a BGL less than 70 mg/dL (3.9 mmol/L), within 5 h post-administration. Secondary outcomes included hypoglycaemia severity, time to hypoglycaemia, risk factors for hypoglycaemia, blood glucose and potassium monitoring. Data collection spanned January 1, 2019 to May 1, 2020. Results: Among 90 patients, 51 % were receiving chronic renal replacement therapies and the incidence of hypoglycaemia and severe hypoglycaemia was 30 % and 6.7 % respectively. Risk factors for hypoglycaemia were lower pre-treatment blood glucose (p=<0.001), absence of diabetes (p=<0.001) and not being prescribed insulin prior to presentation (p = 0.0026). Approximately 50 % of patients received ≤2 blood glucose measurements within 5 h post IDT. Only 44 % of patients had a potassium sample taken in the 1st hour post IDT and 24 % in hour 3. Conclusions: This study demonstrates a higher incidence of hypoglycaemia post-IDT for hyperkalaemia than reported in the general population and estimates the incidence of severe hypoglycaemia in an Australian population. Monitoring of both blood glucose levels (BGL) and potassium was suboptimal. Strategies to improve BGL monitoring and prospective studies to define the optimal dose of insulin-glucose for hyperkalaemia are needed.http://www.sciencedirect.com/science/article/pii/S2773232025000069(MeSH): emergency departmentHyperkalemiaHypoglycemiaInsulinsPotassium |
| spellingShingle | Samuel Ford Julian Williams Ian Coombes Adam La Caze Hypoglycaemia and monitoring practices following insulin-dextrose therapy for hyperkalaemia JEM Reports (MeSH): emergency department Hyperkalemia Hypoglycemia Insulins Potassium |
| title | Hypoglycaemia and monitoring practices following insulin-dextrose therapy for hyperkalaemia |
| title_full | Hypoglycaemia and monitoring practices following insulin-dextrose therapy for hyperkalaemia |
| title_fullStr | Hypoglycaemia and monitoring practices following insulin-dextrose therapy for hyperkalaemia |
| title_full_unstemmed | Hypoglycaemia and monitoring practices following insulin-dextrose therapy for hyperkalaemia |
| title_short | Hypoglycaemia and monitoring practices following insulin-dextrose therapy for hyperkalaemia |
| title_sort | hypoglycaemia and monitoring practices following insulin dextrose therapy for hyperkalaemia |
| topic | (MeSH): emergency department Hyperkalemia Hypoglycemia Insulins Potassium |
| url | http://www.sciencedirect.com/science/article/pii/S2773232025000069 |
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