Acute and Critical Care

Original Articles

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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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

Basic science and research
Changes in Insulin-like Growth Factor-1 Level in Patients with Sepsis and Septic Shock: Sang Hoon Lee, Byung Hoon Park, Joo Han Song, Song Yee Kim, Kyung Soo Chung, Eun Young Kim, Ji Ye Jung, Young Sam Kim, Se Kyu Kim, Joon Chang, Moo Suk Park; Korean J Crit Care Med. 2016;31(4):324-333. Published online November 30, 2016; DOI: https://doi.org/10.4266/kjccm.2016.00024

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Abstract PDF

Background
Despite many ongoing, prospective studies on the topic, sepsis still remains one of the main causes of death in hospital. The hormone insulin-like growth factor 1 (IGF-1) has a similar molecular structure to that of insulin. IGF-1 exerts anabolic effects and plays important roles in both normal physiology and pathologic processes. Previous studies have observed low serum IGF-1 level in patients with critical illnesses. Here, we evaluated changes in IGF-1 level based on survival of septic patients.
Methods
We evaluated 140 patients with sepsis and septic shock (21 with sepsis and 119 with septic shock) admitted to the intensive care unit of a university-affiliated hospital in Korea. Serum IGF-1 level was measured on days 0, 1, 3, and 7. Patients with liver disease were excluded from this study. All data were analyzed using SPSS version 20 (SPSS Inc., Chicago, IL, USA).
Results
Patients with septic shock had significantly lower serum IGF-1 level on days 1 and 3 than patients without septic shock (p = 0.002 and p = 0.007, respectively). Generally, there was a negative relationship between IGF-1 and serum cortisol levels; however, this relationship was only significant on day 3 (p = 0.029). Furthermore, renin showed significantly negative correlation with IGF-1 on day 3 (p = 0.038). IGF-1 level did not show significant difference between survivors and non-survivors.
Conclusions
Our results showed that IGF-1 was associated with septic shock, and that the IGF-1 axis is severely disrupted in septic patients. Additionally, serum cortisol and renin levels were associated with IGF-1 level.

Citations

Citations to this article as recorded by

Lower Initial Insulin-like Growth Factor-Binding Protein-3 Concentrations May Reflect Immune Suppression and Predict Increased Risk of Sepsis-Related Mortality
Filippo Mearelli, Alessio Nunnari, Federica Chitti, Annalisa Rombini, Alessandra Macor, Donatella Denora, Luca Messana, Marianna Scardino, Ilaria Martini, Giulia Bolzan, Francesca Spagnol, Chiara Casarsa, Nicola Fiotti, Verena Zerbato, Stefano Di Bella, C
International Journal of Molecular Sciences.2025; 26(14): 6549. CrossRef

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