Bolus administration of intravenous glucose in the treatment of hyperkalemia : a randomized controlled trial
Date
2014-02
Authors
Chothia, Mogamat-Yazied
Halperin, Mitchell L.
Rensburg, Megan A.
Hassan, Mogamat Shafick
Davids, Mogamat Razeen
Journal Title
Journal ISSN
Volume Title
Publisher
Karger
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.
Description
Please cite as follows:
Chothia, M-Y. et al. 2014. Bolus Administration of Intravenous Glucose in the Treatment of Hyperkalemia: A Randomized Controlled Trial. Nephron Physiology, 1(26):1-8, doi:10.1159/000358836.
The original publication is available at http://www.karger.com/Journal/Issue/261595
Chothia, M-Y. et al. 2014. Bolus Administration of Intravenous Glucose in the Treatment of Hyperkalemia: A Randomized Controlled Trial. Nephron Physiology, 1(26):1-8, doi:10.1159/000358836.
The original publication is available at http://www.karger.com/Journal/Issue/261595
Keywords
Hyperkalemia -- Treatment, Arrhythmia -- Treatment
Citation
Chothia, M-Y. et al. 2014. Bolus Administration of Intravenous Glucose in the Treatment of Hyperkalemia: A Randomized Controlled Trial. Nephron Physiology, 1(26):1-8, doi:10.1159/000358836.