(935) Evaluation of Hypoglycemia With Insulin Dosing for the Treatment of Hyperkalemia

Introduction: Acute management of hyperkalemia includes calcium to stabilize the cardiac membrane and agents such as insulin and albuterol to shift potassium intracellularly. Although relatively safe, insulin is associated with a risk of hypoglycemia especially in patients with renal dysfunction (chronic kidney disease stages III-V). This study compared the incidence of hypoglycemia between weight-based dosing (0.1 units/kg) and a fixed dose (10 units) of regular IV insulin for the treatment of hyperkalemia.

Methods: This retrospective, single-center cohort study evaluated adult patients admitted between May 1, 2023, through October 31, 2023, who received a single dose of regular IV insulin for the management of hyperkalemia (serum potassium >5 mmol/L). Patients who received more than one dose of IV insulin within twenty-four hours of initial insulin administration for hyperkalemia were excluded. The primary outcome was the incidence of hypoglycemia (blood glucose ≤70 mg/dL) within six hours of insulin administration. Secondary endpoints included the incidence of severe hypoglycemia (blood glucose ≤50 mg/dL) and the incidence of hypoglycemia in patients with renal dysfunction within six hours of insulin administration. A sample size of 438 patients was calculated as necessary to achieve 80% power with a two-sided alpha level of 5%.

Results: The study included 237 patients, of whom 141 (59%) received weight-based dosing and 96 (41%) received fixed dosing. Median age was 63 years old. Among them, 56% were male, and 65% had renal dysfunction. Hypoglycemia occurred in 20.6% of the weight-based group and 16.7% of the fixed dose group (p = 0.452). A subgroup analysis of the primary outcome was performed evaluating hypoglycemia in patients with renal dysfunction and a statistically significant difference was not detected.

Conclusions: There was no difference in hypoglycemic events among patients who received weight-based versus fixed dose insulin for the treatment of hyperkalemia.