Evaluation of Hypoglycemia Incidence and Risk Factors in Patients Treated with IV Insulin Aspart for Hyperkalemia

Evaluation of Hypoglycemia Incidence and Risk Factors in Patients Treated with IV Insulin Aspart for Hyperkalemia

Purpose: Intravenous (IV) insulin aspart is an effective treatment option for hyperkalemia in the hospital setting. IV dextrose is commonly administered prior to IV insulin aspart to prevent hypoglycemia; however, hypoglycemia has been identified in patients receiving this therapy. This study aimed to determine the incidence of hypoglycemia in patients receiving IV insulin aspart for hyperkalemia.
Methods: This was a single-center, retrospective cohort study evaluating the incidence of hypoglycemia in 86 patients who received IV insulin aspart for hyperkalemia. Secondarily, this study aimed to determine the percentage of patients who received dextrose prior to IV insulin aspart, percentage of patients who became hypoglycemic when not receiving IV dextrose prior to insulin treatment, the median time to first hypoglycemic event, and patient characteristics associated with hypoglycemia in this sample population.
Results: Fifteen (17%) patients developed hypoglycemia (blood glucose (BG) <70 mg/dL) while three (4%) patients developed severe hypoglycemia (BG<40 mg/dL). Only three patients did not receive IV dextrose prior to IV insulin aspart, and they did not become hypoglycemic. The median time between IV insulin aspart administration and hypoglycemia was 87(Inter quartile range (IQR) 63-108) minutes. Those who did not develop hypoglycemia had an average pretreatment BG 43.5 mg/dL (95% Confidence interval (CI) 12.8-74.3) mg/dL higher than those who did develop hypoglycemia. Other patient characteristics were not significantly associated with hypoglycemia.
Conclusion: Lower BG values prior to IV insulin aspart administration were associated with an increased risk of hypoglycemia. Alternative hyperkalemia treatment doses of dextrose and insulin as well as BG monitoring beyond one hour may be necessary in order to prevent
hypoglycemia or detect it before symptoms develop.