Scientific Poster Session III - Students Research-in-Progress

Students Research in Progress
  Monday, October 14, 2024
  01:00 PM–02:30 PM

Abstract

Introduction: One effective treatment strategy for hyperkalemia includes IV push insulin. Despite dextrose co-administration, this treatment carries the risk of hypoglycemia defined as blood glucose (BG) below 70 mg/dL. This project evaluates the incidence of hypoglycemia in patients treated with IV insulin for hyperkalemia and determines risk factors for those who experienced hypoglycemia.

Research Question or Hypothesis: What is the incidence of hypoglycemia after IV push insulin lispro administration for hyperkalemia?

Study Design: A single-center, observational retrospective chart review evaluated 540 patients who received IV insulin lispro for hyperkalemia between May 1 and December 31, 2023.

Methods: The primary endpoint was the incidence of hypoglycemia, with the secondary endpoints examining patient demographics and specific treatments.

Results: Most patients received insulin lispro 5 units IV Push (92.8%) and 99.4% received dextrose co-administration. Hypoglycemia occurred in 13.9% of patients. In patients who received more than one dose of IV push insulin for hyperkalemia (39.8%), 19.1% developed hypoglycemia versus 10.5% of encounters with only one dose (p<0.05). Median baseline BG was lower in patients who developed hypoglycemia (95 versus 135, p<0.05). Hypoglycemia occurred in 20.5% of patients on hemodialysis and 10% of patients with diabetes. Of the patients who received dextrose co-administration, 77.2% received 100 mL and 21.9% received 50 mL. Few patients (9.4%) received a continuous dextrose 10% infusion. No significant difference in hypoglycemia incidence was found based on diabetes status, dose of IV push insulin, median long-acting insulin administered within 24 hours before or 12 hours after the IV push (p=0.45), or dextrose dose co-administered (p<0.05).

Conclusion: Despite dextrose co-administration, hypoglycemia occurred frequently. A higher incidence of hypoglycemia was observed in patients receiving more than one dose of IV push insulin lispro, patients on hemodialysis, and those with a lower baseline glucose. Continuous infusion or higher doses of dextrose may be needed to prevent hypoglycemia in these at-risk patient populations.

Presenting Author

Natalie Horgan PharmD Student
Indiana University Health

Authors

Emma Heltzel BSPH
Indiana University Health

Alison Lewis PharmD
Indiana University Health

Emily Miller PharmD
IU Health

Reed Overton PharmD Student
Indiana University Health

Eryne Wiethorn PharmD
Indiana University Health