Reducing the harm associated in treating hyperkalaemia with insulin and dextrose

Area of Science:

• Nephrology
• Endocrinology
• Clinical Pharmacology

Background:

• Inpatient treatment of hyperkalaemia with insulin and dextrose is a common practice.
• This treatment can lead to iatrogenic hypoglycemia, particularly in patients with renal disease.
• The incidence and impact of hypoglycemia in this population require further investigation.

Purpose of the Study:

• To assess the incidence of hypoglycemia in hospitalized patients with renal disease receiving insulin and dextrose for hyperkalaemia.
• To evaluate the impact of a new local guideline on reducing iatrogenic hypoglycemia.
• To determine the effectiveness of sodium zirconium cyclosilicate (SZC) in managing moderate hyperkalaemia and preventing hypoglycemia.

Main Methods:

• An observational period was conducted to establish the baseline burden of hypoglycemia.
• A local guideline was introduced, incorporating hourly capillary blood glucose monitoring for up to 6 hours post-insulin administration.
• Sodium zirconium cyclosilicate (SZC) was introduced for patients with moderate hyperkalaemia alongside changes in patient care protocols.

Main Results:

• A significant burden of iatrogenic hypoglycemia was identified in the initial observation period.
• The implementation of the new guideline, including SZC and enhanced monitoring, led to more appropriate use of insulin and dextrose.
• A significant 73% reduction in the iatrogenic burden of hypoglycemia was observed (P = 0.04).

Conclusions:

• The introduction of sodium zirconium cyclosilicate (SZC) and revised patient care guidelines effectively reduced iatrogenic hypoglycemia in hospitalized renal patients.
• Enhanced monitoring protocols are crucial for managing hyperkalaemia treatment risks.
• SZC represents a valuable therapeutic option for moderate hyperkalaemia, mitigating the risk of hypoglycemia.