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The appropriate dose of insulin to minimize hypoglycemic events when using for the treatment of hyperkalemia in patients with renal insufficiency is still debated.
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| Mechanism | Cause an intracellular shift of potassium via exchange of sodium ions via the Na+/K+ ATPase pump |
| Dose | 5-10 units Doses of 0.1 units/kg (max 10 units) have also been considered |
| Administration | IV push |
| PK/PD | Onset: 15-30 minutes for initial potassium lowering effects Duration: 4-6 hours, prolonged duration in ESRD |
| Adverse Effects | Hypoglycemia, hypokalemia, hypersensitivity |
| Compatibility | Can dilute in normal saline to increase volume for ease of administration |
| Pearls | Must be given with dextrose (25g IV) to prevent hypoglycemia —–Some patients require repeated dextrose; rare exceptions for those already extremely hyperglycemic The most commonly used product is regular human insulin given IV to ensure the fast onset of potassium lowering effects and prevent variable absorption |
| Author, Year | Design (Sample Size) | Intervention & Comparison | Outcomes |
|---|---|---|---|
| Moussavi et al., 2021 | Meta-analysis (n = 3437) | 10 units vs <10 units IV regular insulin | • <10 units IV regular insulin had lower pooled odds of hypoglycemia odds ratio [OR] 0.55 and severe hypoglycemia OR 0.41 • No difference in potassium reduction was detected mean difference -0.02 mmol/L |
| Verdier et al., 2021 | Single-center, retrospective (n =174) | 5 units vs 10 units IV regular insulin in ICU patients | • Hypoglycemia was more frequent with 10 units vs 5 units of IV insulin (19.5 vs 9.2%, p=0.052) • No difference in rates of severe hypoglycemia or change in serum potassium |
Moussavi et al conducted a Meta-analysis (n = 3437) that looked at 10 units vs <10 units IV regular insulin. They found that <10 units IV regular insulin had lower pooled odds of hypoglycemia odds ratio [OR] 0.55 and severe hypoglycemia OR 0.41
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