Dr Wen Yek1, Dr Tiffany Lee1, Ms Angela Cheaib1, Ms Laura Hoskin1, A/Prof Gerry Fegan1,2, Dr Ed O’Loughlin1, Ms Catherine Li1, A/Prof. Jagadish Shivalingappa Jamboti1,2
1Fiona Stanley Hospital, Murdoch, Perth, Australia, 2Curtin University, Bentley, Perth, Australia
Aim
The purpose of this study is to investigate the incidence of hypoglycaemia following the current insulin protocol for treatment of hyperkalaemia.
Background
Insulin is often used to treat hyperkalaemia in hospitalised patients. As a result, hypoglycaemia is a potential complication. The current protocol at our hospital includes the administration of 10 units insulin with 50mL glucose 50% for the treatment of hyperkalaemia, similar to most other protocols. As part of the Hospital Acquired Complications (HACs) reduction exercise, we studied the incidence of hypoglycaemia following insulin administration and associated risk factors.
Methods
We conducted a retrospective audit of hospitalised patients with hyperkalaemia who received insulin as per hospital protocol between August 2020 and January 2021. 207 patients were identified, of which 15 patients were excluded as their post-treatment blood glucose levels were not recorded. The remaining 192 patients were assessed for the incidence and risk factors of developing hypoglycaemia.
Results
Fifteen episodes of hypoglycaemia (7.8%) were identified among 192 hyperkalaemic patients treated with insulin. 10 patients had blood glucose levels (BGL) between 3 to 4 mmol/L (5.2%) whereas 5 developed clinically significant hypoglycaemia with BGL < 3mmol/L (2.6%). Hypoglycaemia occurred on an average of 4 hours following insulin administration. 165/192 patients had acute kidney injury or chronic kidney disease of whom 13 developed hypoglycaemia (7.9%). Among 59 patients with type 1 or 2 diabetes on regular insulin therapy, 3 developed hypoglycaemia (5%).
Conclusions
The incidence of hypoglycaemia following the current protocol of insulin administration is significant and the risk of exposure is elevated in patients with renal dysfunction. We need to consider a revised insulin protocol to treat hyperkalaemia to minimise the risk of hypoglycaemia.
Biography:
Bio to come