In this episode, I’ll discuss the dose of insulin to treat hyperkalemia.
Back in episodes 653 and 612 I discussed using a lower dose of insulin (5 units instead of 10) to treat hyperkalemia, and this practice has become more common because it seems to offer equivalent reduction in serum potassium levels with a lower risk of hypoglycemia. However, whether this advantage holds up even in patients who are overweight or obese is unknown. Therefore, a group of authors published in Pharmacotherapy a multicenter, retrospective cohort study to compare 5 units of regular insulin with 10 units to treat hyperkalemia in patients with a BMI of 25 or greater.
In total, 81 patients received 5 units and 81 patients received 10 units. The primary outcome for the study was the effect on lowering serum potassium of 5 units versus 10 units of intravenous regular insulin. Secondary outcomes include the incidence of hypoglycemic episodes within 6 hours of insulin administration, length of stay, and treatment failure.
There was no difference between groups in terms of potassium lowering efficacy, with both doses resulting in a drop in serum potassium of 0.5 mEq/L. In addition, there were no significant differences in any of the secondary outcomes between groups.
The authors concluded:
In this small, retrospective cohort study, treatment with 5 units of intravenous regular insulin did not compromise the serum potassium-lowering effect when compared to 10 units in overweight patients with hyperkalemia. Further controlled studies are warranted to confirm these findings.
This study adds to the available knowledge because none of the previous studies using lower insulin doses to treat hyperkalemia focused on overweight patients. Although the study is described as focusing on overweight patients, all patients weighed over 100kg, and all but 5 were obese with a BMI above 30, further increasing the generalizability of these results.
The article in this episode is a selection from my Hospital Pharmacy Academy’s weekly literature digest. Have you ever felt like your physician colleagues are one step ahead of you with new literature developments? Every week, Academy members are provided a summary curated and explained by me of the top hospital pharmacy-related articles published that week from over 20 major journals and sources to save you time and keep you up to date with the literature. To get immediate access, go to pharmacyjoe.com/academy.
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