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Original Article
- CPR/Resuscitation
- Incidence of hypoglycemia in hyperkalemia patients after treatment with insulin and dextrose in the emergency department of a tertiary care hospital in India: a prospective observational study
- Vivek Chaurasia, Nayer Jamshed, Praveen Aggrawal, Sanjeev Bhoi, Meera Ekka, Tej Prakash Sinha, Akshay Kumar, Prakash Ranjan Mishra, Anand Kumar Das
- Acute Crit Care. 2024;39(4):499-506. Published online November 22, 2024
- DOI: https://doi.org/10.4266/acc.2024.00661
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- 215 Download
- 2 Web of Science
- 2 Crossref
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Abstract
PDF - Background
Hypoglycemia is a serious, often overlooked complication of treating hyperkalemia with insulin and dextrose. If not recognized and managed, it can increase morbidity and mortality. This study aimed to estimate the incidence of hypoglycemia in hyperkalemic patients treated with 10 units of intravenous insulin, 50 ml of 50% dextrose, 10 ml of 10% calcium gluconate, and salbutamol nebulization. Additionally, the timing of hypoglycemia onset and its associated factors were studied.
Methods
This prospective observational study included hyperkalemic patients (serum potassium >5.5 mmol/L) who visited the emergency department between January 26, 2020, and August 26, 2021. The primary outcome was hypoglycemia (blood glucose <70 mg/dl) within 3 hours of receiving the standard treatment. Glucose levels were measured hourly for 3 hours. Univariate and multivariate logistic regression identified factors associated with hypoglycemia.
Results
Of 100 patients, 69% were male, and the median age was 46 years (IQR, 30–60 years). Hypoglycemia occurred in 44%, and 10% developed severe hypoglycemia (blood glucose <54 mg/dl). The median time for hypoglycemia onset was 2 hours (IQR, 1–2 hours). Low pretreatment blood glucose (<100 mg/dl) was significantly associated with hypoglycemia, according to both univariate and multivariate analyses.
Conclusions
The study found a higher incidence of hypoglycemia in hyperkalemia treatment than reported in retrospective studies, suggesting the need for standardized management protocols with integrated glucose monitoring. -
Citations
Citations to this article as recorded by
- Acute hyperkalaemia in emergency care: evidence-based approaches
Niclas Geldermann, Julia Dzimiera, Henning Fischer, Michael Christ
Emergency Medicine Journal.2026; : emermed-2025-215469. CrossRef - Risk of hypoglycemia in hyperkalemia management with insulin among inpatients-experience in an acute care tertiary hospital
Siew Hoon Lim, Shin Yuh Ang, Siti Namira Binte Abdul Wahab, Ming Ming Teh, Fazila Aloweni
Proceedings of Singapore Healthcare.2025;[Epub] CrossRef
- Acute hyperkalaemia in emergency care: evidence-based approaches
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