Data from: Hypoglycemia Following intravenous insulin plus glucose for hyperkalemia in patients with impaired renal function

Background: Hypoglycemia is a serious complication following the administration of insulin for hyperkalemia. We determined the incidence of hypoglycemia and severe hypoglycemia (blood glucose <70 or ≤40 mg/dl, respectively) in a cohort of AKI and non-dialysis dependent CKD patients who received an intravenous infusion of insulin plus glucose to treat hyperkalemia.
Methods: We retrospectively reviewed charts of all AKI and non-dialysis dependent CKD patients who received 10 U of insulin plus 50 g glucose to treat hyperkalemia from December 1, 2013 to May 31, 2015 at our Department.
Results: One hundred sixty four episodes of hyperkalemia were treated with insulin plus glucose and were eligible for analysis. Serum potassium levels dropped by 1.18 ± 1.01 mmol/l. Eleven treatments (6.1%) resulted in hypoglycemia and two (1.2%) in severe hypoglycemia. A lower pretreatment blood glucose tended to associate with a higher subsequent risk of hypoglycemia. Age, sex, renal function, an established diagnosis of diabetes or previous treatment were not associated with the development of this complication. We did not register any significant adverse events.
Conclusion: Our intravenous regimen combining an infusion of insulin plus glucose effectively reduced serum potassium levels compared to previous studies and associated a low risk of symptomatic hypoglycemia and other complications.

背景：高钾血症（Hyperkalemia）患者接受胰岛素治疗后，低血糖症（Hypoglycemia）是一种严重的并发症。本研究旨在明确接受静脉输注（intravenous infusion）胰岛素联合葡萄糖治疗高钾血症的急性肾损伤（AKI, Acute Kidney Injury）及非透析依赖型慢性肾脏病（CKD, Chronic Kidney Disease）队列中，低血糖症及严重低血糖症（分别定义为血糖<70 mg/dl、≤40 mg/dl）的发生率。
方法：本研究回顾性分析了2013年12月1日至2015年5月31日期间，我科所有接受10单位胰岛素联合50克葡萄糖静脉输注治疗高钾血症的AKI及非透析依赖型CKD患者的病历资料。
结果：共计164例次高钾血症发作接受胰岛素联合葡萄糖治疗并纳入分析。患者血清钾水平较治疗前下降1.18±1.01 mmol/L。其中11例次治疗（占比6.1%）出现低血糖症，2例次（占比1.2%）出现严重低血糖症。治疗前血糖水平越低，后续发生低血糖症的风险呈升高趋势。年龄、性别、肾功能状况、确诊糖尿病病史或既往治疗史均与该并发症的发生无显著关联。本研究未记录到任何显著不良事件。
结论：相较于既往研究，本研究采用的胰岛素联合葡萄糖静脉输注方案可有效降低血清钾水平，且症状性低血糖症及其他并发症的发生风险较低。