Bolus administration of intravenous glucose in the treatment of hyperkalemia : a randomized controlled trial

Chothia, Mogamat-Yazied ; Halperin, Mitchell L. ; Rensburg, Megan A. ; Hassan, Mogamat Shafick ; Davids, Mogamat Razeen (2014-02)

Please cite as follows:

Chothia, M-Y. et al. 2014. Bolus Administration of Intravenous Glucose in the Treatment of Hyperkalemia: A Randomized Controlled Trial. Nephron Physiology, 1(26):1-8, doi:10.1159/000358836.

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Background: Hyperkalemia is a common medical emergency that may result in serious cardiac arrhythmias. Standard therapy with insulin plus glucose reliably lowers the serum potassium concentration ([K + ]) but carries the risk of hypoglycemia. This study examined whether an intravenous glucose- only bolus lowers serum [K + ] in stable, nondiabetic, hyperkalemic patients and compared this intervention with insulin-plus-glucose therapy. Methods: A randomized, crossover study was conducted in 10 chronic hemodialysis patients who were prone to hyperkalemia. Administration of 10 units of insulin with 100 ml of 50% glucose (50 g) was compared with the administration of 100 ml of 50% glucose only. Serum [K + ] was measured up to 60 min. Patients were monitored for hypoglycemia and EKG changes. Results: Baseline serum [K + ] was 6.01 ± 0.87 and 6.23 ± 1.20 mmol/l in the insulin and glucose-only groups, respectively (p = 0.45). At 60 min, the glucose-only group had a fall in [K + ] of 0.50 ± 0.31 mmol/l (p < 0.001). In the insulin group, there was a fall of 0.83 ± 0.53 mmol/l at 60 min (p < 0.001) and a lower serum [K + ] at that time compared to the glucose-only group (5.18 ± 0.76 vs. 5.73 ± 1.12 mmol/l, respectively; p = 0.01). In the glucose-only group, the glucose area under the curve (AUC) was greater and the insulin AUC was smaller. Two patients in the insulin group developed hypoglycemia. Conclusion: Infusion of a glucose-only bolus caused a clinically significant decrease in serum [K + ] without any episodes of hypoglycemia.

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