Q: How intravenous (IV) insulin and IV 5%-dextrose works in hyperkalemia?
Answer: Although it is true that insulin is administrated with dextrose in the treatment of hyperkalemia to avoid hypoglycemia, there is another vital reason to do it.
Dextrose and insulin works synergistically in hyperkalemia. IV 5% dextrose in water stimulates endogenous insulin, which along with IV insulin drives extracellular potassium into cells.
Dextrose infusion should precede the insulin bolus.
#electrolytes
#endocrinology
References:
Moussavi K, Fitter S, Gabrielson SW, Koyfman A, Long B. Management of Hyperkalemia With Insulin and Glucose: Pearls for the Emergency Clinician. J Emerg Med. 2019 Jul;57(1):36-42. doi: 10.1016/j.jemermed.2019.03.043. Epub 2019 May 11. PMID: 31084947.
Crnobrnja L, Metlapalli M, Jiang C, Govinna M, Lim AKH. The Association of Insulin-dextrose Treatment with Hypoglycemia in Patients with Hyperkalemia. Sci Rep. 2020 Dec 16;10(1):22044. doi: 10.1038/s41598-020-79180-7. PMID: 33328554; PMCID: PMC7745028.
Ljutić D, Rumboldt Z. Should glucose be administered before, with, or after insulin, in the management of hyperkalemia? Ren Fail. 1993;15(1):73-6. doi: 10.3109/08860229309065576. PMID: 8441841.
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