Comparison of IV Insulin Dosing Strategies for Hyperkalemia in the Emergency Department

Crit Care Explor. 2020 Apr 29;2(4):e0092. doi: 10.1097/CCE.0000000000000092. eCollection 2020 Apr.


The objectives of this study were to evaluate the safety and efficacy of insulin dosing of less than 10 units versus 10 units in patients receiving hyperkalemia treatment.

Design: Retrospective single-center study.

Setting: Emergency department at a large academic medical center in the United States.

Patients: Seven hundred adults treated for hyperkalemia with IV regular insulin between April 1, 2013, and September 27, 2018.

Interventions: Patients that received less than 10 units of insulin were compared to those that received 10 units of insulin.

Measurements and main results: Patients treated with less than 10 units had significantly lower frequency of hypoglycemia (11.2% vs 17.6%; p = 0.008). Reduction in serum potassium was significantly more modest in size in patients treated with less than 10 units (mean reduction 0.94 ± 0.71 mMol/L) compared with patients treated with 10 units (mean reduction 1.11 ± 0.8 mMol/L; p = 0.008). There were no statistically significant differences between groups in time to hypoglycemia, nadir serum glucose, severe hypoglycemia (<40 mg/dL), dextrose requirements, use of concurrent agents for hyperkalemia, need for repeat insulin dosing, length of stay, or mortality.

Conclusions: Patients treated for hyperkalemia with insulin doses less than 10 units had reduced frequency of hypoglycemia; however, potassium reduction post treatment was more modest in these patients. These findings suggest providers choosing to administer 10 units IV insulin should ensure patients have adequate monitoring for hypoglycemia.

Keywords: emergency medicine; hyperkalemia; hypoglycemia; insulin; intensive care units; length of stay.