The highest risk for hypoglycemia after treatment for hyperkalemia is in the emergency department
Binz S, Konowitz N, Bennet S, and Miller J. The highest risk for hypoglycemia after treatment for hyperkalemia is in the emergency department. Academic Emergency Medicine 2020; 27:S118.
Academic emergency medicine
Background and Objectives: Hypoglycemia is one of the most complications of treatment for hyperkalemia with insulin and glucose. The objective of this analysis was to test if rates of hypoglycemia following hyperkalemia treatment differ between the ED and inpatient units.
Methods: We performed a retrospective observational study across 4 hospitals that were inclusive of consecutive ED and hospitalized adults that received insulin and 25 grams of glucose for the management of hyperkalemia over a 12-month period. We excluded patients treated in the setting of cardiac arrest. The primary outcome was hypoglycemia (glucose < 70 mg/dL) following treatment. We performed chi-square and ANOVA comparisons between the ED, general practice units (GPU) and intensive care units (ICU). We then performed multivariate logistic regression to adjust for confounding variables in assessing the primary outcome.
Results: The study included 1,291 patients, of whom 539 (41.2%) were female, 416 (31.9%) were on dialysis, and the mean age was 62.2 ±15.3 years. The cohort included 502 patients treated in the ED, 353 in the GPU, and 436 in the ICU. The mean pre-treatment potassium in ED patients (6.4 ±0.9 mEq/L) was higher (p<0.001) compared to the GPU (5.9 ±0.5 mEq/L) and ICU patients (6.0 ±0.6 mEq/L). Pre-treatment glucose in ED patients (133 ±64 mg/dL) was lower (p<0.001) than in the GPU (154 ±73 mg/dL) and ICU patients (158 ±78 mg/dL). There were 238 (18.4%) hypoglycemic events: 117 (23.3%) in the ED, 65 (18.4%) in the GPU, and 56 (12.8%) in the ICU (p<0.001). After adjusting for gender, diabetes, dialysis, weight, age, creatinine, insulin dose, and pretreatment glucose, the odds of hypoglycemia complicating treatment of hyperkalemia in the ED was 1.9 (95% CI 1.3 - 2.8) compared to treatment in the ICU. Compared to the GPU, the higher OR was 1.3 (95% CI 0.9 - 1.9).
Conclusion: In this study, patients treated for hyperkalemia in the ED had the highest adjusted odds of hypoglycemia compared to patients treated in the hospital.