insulin and D-50 treatment for high K

Q: In hyperkalemic emergency, a bolus of 10 units of regular insulin with 1 amp of D-50 glucose is expected to drop potassium by how much?

Answer: approximately 1 mEq/L

Untreated hyperkalemia can be fatal. Even if there are no EKG changes, various measures should be applied, including administering calcium, bicarbonate, and insulin/dextrose combo.

10 units of regular insulin, followed immediately by 50 mL of 50 percent dextrose, is expected to reduce serum potassium by 1 mEq/L. It is common for clinicians to forget at the bedside that despite regular insulin, the insulin levels remain high long enough to cause hypoglycemia an hour or more after. Insulin gets effective within 10-20 minutes, peaks at 30-60 minutes, and may last for 4-6 hours. Glucose levels should be monitored for a few hours in such instances. This gets significantly important in patients with renal insufficiency, where insulin's half-life can be prolonged.

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References:

1. Harel Z, Kamel KS. Optimal Dose and Method of Administration of Intravenous Insulin in the Management of Emergency Hyperkalemia: A Systematic Review. PLoS One 2016; 11:e0154963.

2. Tee SA, Devine K, Potts A, et al. Iatrogenic hypoglycaemia following glucose-insulin infusions for the treatment of hyperkalaemia. Clin Endocrinol (Oxf) 2021; 94:176.

3. Lens XM, Montoliu J, Cases A, et al. Treatment of hyperkalaemia in renal failure: salbutamol v. insulin. Nephrol Dial Transplant 1989; 4:228.

4. Emmett M. Non-dialytic treatment of acute hyperkalemia in the dialysis patient. Semin Dial 2000; 13:279.