Q: In kidney failure patients who get treated for hyperkalemia with insulin and glucose, which effect is relatively more resistant? - select one
A) Glucose-lowering effect of insulin
B) Hypokalemic effect of insulin and glucose
Answer: A
Renal failure patients who require emergent treatment for hyperkalemia are usually resistant to the glucose-lowering effect of insulin but not to the hypokalemic effect. This is because their Na-K-ATPase activity remains elevated.
Glucose/insulin combo starts working in 10 to 20 minutes, peaks at 30 to 60 minutes, and lasts for about 4-6 hours.
#endocrinology
#electrolytes
#nephrology
References:
1. Emmett M. Non-dialytic treatment of acute hyperkalemia in the dialysis patient. Semin Dial 2000; 13:279.
2. Goecke IA, Bonilla S, Marusic ET, Alvo M. Enhanced insulin sensitivity in extrarenal potassium handling in uremic rats. Kidney Int 1991; 39:39.
3. Alvestrand A, Wahren J, Smith D, DeFronzo RA. Insulin-mediated potassium uptake is normal in uremic and healthy subjects. Am J Physiol 1984; 246:E174.
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