Observational study of the relative efficacy of insulin-glucose treatment for hyperkalaemia in patients with liver cirrhosis

BMJ Open. 2021 Oct 22;11(10):e051201. doi: 10.1136/bmjopen-2021-051201.


Objectives: To determine if liver cirrhosis is associated with reduced efficacy of insulin-glucose treatment in moderate to severe hyperkalaemia.

Design: Retrospective, cohort study.

Setting: Two secondary and one tertiary care hospital at a large metropolitan healthcare network in Melbourne, Australia.

Participants: This study included 463 adults with a mean age of 68.7±15.8 years, comprising 79 patients with cirrhosis and 384 without cirrhosis as controls, who received standard insulin-glucose treatment for a serum potassium ≥6.0 mmol/L from October 2016 to March 2020. Patients were excluded if they received an insulin infusion, or if there was inadequate follow-up data for at least 6 hours after IDT due to death, lost to follow-up or inadequate biochemistry monitoring. The mean Model for End-stage Liver Disease score in patients with cirrhosis was 22.2±7.5, and the distribution of the Child-Pugh score for cirrhosis was: class A (24%), class B (46%), class C (30%).

Outcome measures: The primary outcome was the degree of potassium lowering and the secondary outcome was the proportion of patients who achieved normokalaemia, within 6 hours of treatment.

Results: The mean pretreatment potassium for the cohort was 6.57±0.52 mmol/L. After insulin-glucose treatment, mean potassium lowering was 0.84±0.58 mmol/L in patients with cirrhosis compared with 1.33±0.75 mmol/L for controls (p<0.001). The proportion of patients achieving normokalaemia was 33% for patients with cirrhosis, compared with 53% for controls (p=0.001). By multivariable regression, on average, liver cirrhosis was associated with a reduced potassium lowering effect of 0.42 mmol/L (95% CI 0.22 to 0.63 mmol/L, p<0.001) from insulin-glucose treatment, after adjusting for age, serum creatinine, cancer, pretreatment potassium level, β-blocker use and cotreatments (sodium polystyrene sulfonate, salbutamol, sodium bicarbonate).

Conclusions: Our observational data suggest reduced efficacy of insulin-glucose treatment for hyperkalaemia in patients with cirrhosis.

Keywords: accident & emergency medicine; clinical pharmacology; gastroenterology; general endocrinology; internal medicine; therapeutics.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • End Stage Liver Disease*
  • Glucose
  • Humans
  • Hyperkalemia* / drug therapy
  • Insulin
  • Liver Cirrhosis / complications
  • Liver Cirrhosis / drug therapy
  • Middle Aged
  • Retrospective Studies
  • Severity of Illness Index


  • Insulin
  • Glucose