Assessment of dextrose 50 bolus versus dextrose 10 infusion in the management of hyperkalemia in the ED
| Autor: | Irene Yang, Tania Ahuja, Samantha Smalley, John Papadopoulos, Cristian Merchan, Silas W. Smith |
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| Rok vydání: | 2019 |
| Předmět: |
Blood Glucose
Male Hyperkalemia medicine.medical_treatment Economic shortage Hypoglycemia 03 medical and health sciences 0302 clinical medicine Bolus (medicine) parasitic diseases Clinical endpoint Medicine Humans Insulin Adverse effect Infusions Intravenous Aged Retrospective Studies Dose-Response Relationship Drug business.industry Incidence nutritional and metabolic diseases Disease Management 030208 emergency & critical care medicine General Medicine Emergency department Middle Aged medicine.disease United States Glucose Treatment Outcome Anesthesia Sweetening Agents Emergency Medicine Female medicine.symptom business Emergency Service Hospital |
| Zdroj: | The American journal of emergency medicine. 38(3) |
| ISSN: | 1532-8171 |
| Popis: | Introduction Hypoglycemia is a common adverse effect when intravenous (IV) insulin is administered for hyperkalemia. A prolonged infusion of dextrose 10% (D10) may mitigate hypoglycemia compared to dextrose 50% (D50) bolus. Our objective was to evaluate whether D10 infusion is a safe and effective alternative to D50 bolus for hypoglycemia prevention in hyperkalemic patients receiving IV insulin. Methods We conducted a retrospective review of patients ≥ 18 years who presented to the emergency department (ED) with hyperkalemia (K+ > 5.5) and received IV insulin and D10 infusion or D50 bolus within 3 h. The primary endpoint was incidence of hypoglycemia, defined as blood glucose (BG) ≤ 70 mg/dL, in the 24 h following IV insulin administration for hyperkalemia. Results A total of 134 patients were included; 72 in the D50 group and 62 in the D10 group. There was no difference in incidence of hypoglycemia between the D50 and D10 groups (16 [22%] vs. 16 [26%], p = 0.77). Symptomatic hypoglycemia, severe hypoglycemia, and hyperglycemia rates in the D50 and D10 groups were [5 (7%) vs. 2 (3%), p = 0.45], [5 (7%) vs. 1 (2%), p = 0.22], and [34 (47%) vs. 23 (37%), p = 0.31] respectively. Low initial BG was a predictor for developing hypoglycemia. Conclusions In our study, D10 infusions appeared to be at least as effective as D50 bolus in preventing hypoglycemia in hyperkalemic patients receiving IV insulin. In context of ongoing D50 injection shortages, D10 infusions should be a therapeutic strategy in this patient population. |
| Databáze: | OpenAIRE |
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