Q: A bolus of 10 units of intravenous (IV) regular insulin and 50 mL of 50 percent dextrose(D-50) are expected to lower serum potassium level approximately by? (select one)
A) 1 mEq/L
B) 2 mEq/L
Answer: A
IV Insulin and D-50 are expected to reduce potassium by approximately 1 mEq/L. Insulin drives potassium inside the cells by enhancing Na-K-ATPase pump in skeletal muscles.
The primary objective of this question is to address a common deficiency of inappropriate practice of glucose administration along with IV insulin. Although most clinicians administer D-50 with IV insulin to counter hypoglycemia, the hypoglycemia effect lasts way longer than IV insulin effect, particularly in patients with renal insufficiency. The serum glucose should be measured frequently, like every hour or earlier if clinical signs appear, at least for the next 6 hours.
One unusual caveat that may harm the patient is that hypoglycemia may not manifest quickly but may develop an hour or after the infusions. It is prudent to run IV infusion of D-10 at 30-70 mL/hour for a few hours to avoid unintended consequences of hypoglycemia.
It takes about 10-15 minutes for insulin to take effect.
#endocrinology
#electrolytes
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. Sterns RH, Grieff M, Bernstein PL. Treatment of hyperkalemia: something old, something new. Kidney Int 2016; 89:546.
3. 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.
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