Monitoring Strategies

Of course, additional strategies exist to prevent and recognize hypoglycemia. Patients should have frequent blood glucose monitoring for four to six hours and patients with a serum glucose less than 140 mg/dL should receive dextrose. However, in busy emergency departments crowded with dozens of inpatient boarders, the safest and least systemically taxing dose of intravenous insulin is a dose of five units (or 0.1 unit/kg) unless there is a compelling reason for a higher dose, where a potential reduction of zero to 0.3 mmol/L would likely translate into patient benefit.

Dr. Westafer (@Lwestafer) is an attending physician and research fellow at Baystate Medical Center, clinical instructor at the University of Massachusetts Medical School in Worcester, and co-host of FOAMcast.

References

1. Scott NL, et al. Hypoglycemia as a complication of intravenous insulin to treat hyperkalemia in the emergency department. Am J Emerg Med. 2019;37(2):209-213.
2. Chothia MY, et al. Hypoglycaemia due to insulin therapy for the management of hyperkalaemia in hospitalised adults: A scoping review. PLoS One. 2022;17(5):e0268395.
3. Moussavi K, et al. Reduced alternative insulin dosing in hyperkalemia: A meta-analysis of effects on hypoglycemia and potassium reduction. Pharmacotherapy. 2021;41(7):598-607.
4. Harel Z, Kamel KS. Optimal dose and method of administration of intravenous insulin in the management of emergency hyperkalemia: A systematic review. PLoS One. 2016;11(5):e0154963.
5. Finder SN, et al. 5 versus 10 units of intravenous insulin for hyperkalemia in patients with moderate renal dysfunction. J Emerg Med. 2022;62(3):298-305.
6. Moussavi K, et al. Comparison of IV insulin dosing strategies for hyperkalemia in the emergency department. Crit Care Explor. 2020;2(4):e0092.
7. Lindner G, et al. Acute hyperkalemia in the emergency department: a summary from a Kidney Disease: Improving Global Outcomes conference. Eur J Emerg Med. 2020;27(5):329-337.