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Blood glucose reduction in patients treated with insulin and dextrose for hyperkalaemia
  1. Ahmed Aljabri1,
  2. Stephen Perona2,
  3. Mohannad Alshibani1,
  4. Moteb Khobrani3,
  5. Daniel Jarrell4,
  6. Asad E Patanwala5
  1. 1Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
  2. 2Pharmacy Department, Northwest Medical Center, Tucson, Arizona, USA
  3. 3College of Pharmacy, King Khalid University, Abha, Saudi Arabia
  4. 4Pharmacy Department, Banner University Medical Center, Tucson, Arizona, USA
  5. 5School of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Dr Ahmed Aljabri, Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah 21589, Saudi Arabia; amaljabri{at}kau.edu.sa

Abstract

Background Dextrose is commonly administered with insulin during the management of hyperkalaemia to avoid hypoglycaemia. Previous research has evaluated the incidence of hypoglycaemia; however, none have reported the extent of blood glucose reduction after this regimen. The aim of this study was to better characterise the changes in blood glucose and to identify patients who may have an increased response to insulin.

Methods This was a multicentre retrospective study evaluating adult patients who received a regimen of 10 units of intravenous regular insulin plus 25 g of intravenous dextrose to manage hyperkalaemia between January 2014 and September 2016. The primary outcome was to evaluate the extent of blood glucose reduction (milligram per decilitre) up to 6 hours following the above regimen. Secondary outcomes included incidence of hypoglycaemia (blood glucose <70 mg/dL) and severe hypoglycaemia (blood glucose <40 mg/dL), and predictors of the extent of blood glucose reduction.

Results A total of 90 patients were included. The median blood glucose change over 6 hours was −24 mg/dL (IQR −53 to 6 mg/dL). Hypoglycaemia developed in 20 patients (22.2%, 95% CI 14.1% to 32.2%) and five patients (5.6%, 95% CI 1.8% to 12.5%) had severe hypoglycaemia. Patients who developed hypoglycaemia had a median baseline blood glucose of 110 mg/dL (IQR 80 to 127 mg/dL), which decreased to a median value of 52 mg/dL (IQR 40 to 60 mg/dL). Higher baseline blood glucose was significantly associated with greater blood glucose reduction (coefficient −0.36, 95% CI −0.55 to −0.18, p<0.001).

Conclusions The extent of blood glucose reduction is variable and hypoglycaemia is common. The high incidence of hypoglycaemia highlights the importance of frequent blood glucose monitoring.

  • insulin
  • dextrose
  • hypoglycaemia
  • hyperkalaemia
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Footnotes

  • Presented at The abstract has been presented at the Society of Critical Care Medicine’s (SCCM) 47th Critical Care Congress on 26 February 2018 at San Antonio, Texas, USA.

  • Contributors AA, SP and AEP designed the study. AA, MA and MK collected the data. AA, DJ, MA, MK and SP double-checked the data collection. AEP managed and analysed the data, and all authors helped interpret it. AA drafted the manuscript and all coauthors contributed to its revision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval University of Arizona (ID No: 1609845157).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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