Intravenous Regular Insulin for Treatment of Hyperkalemia in Overweight Patients

Intravenous regular insulin is often used for the management of hyperkalemia due to its rapid onset of action and predictable potassium-lowering effects. Various studies have been conducted to determine optimal insulin dosing strategies that reduce serum potassium levels without increasing hypoglycemia risk. As data shifts towards lower or fixed insulin doses, validating the appropriateness of these dosing regimens for the management of hyperkalemia in overweight patients is warranted. The purpose of this study was to evaluate the serum potassium-lowering effects of 5 units versus 10 units of intravenous regular insulin in hyperkalemic patients with a body mass index (BMI) ≥ 25 kg/m².

A multicenter, retrospective study was performed in adult patients with BMI ≥ 25 kg/m² who received 5 or 10 units of intravenous regular insulin for the treatment of hyperkalemia. The primary outcome was the potassium-lowering effects of 5 units versus 10 units of intravenous regular insulin. Secondary outcomes include the incidence of hypoglycemic episodes within 6 h of insulin administration, hospital length of stay (LOS), and treatment failure.

Of 699 patients screened, 81 patients received 5 units and 81 patients received 10 units. There was no difference in the serum potassium-lowering effects of 5 units versus 10 units of intravenous regular insulin (0.5 (0.1-1.1) mmol/L vs. 0.5 (0.2-1) mmol/L; p = 0.65). No significant differences were observed for any secondary outcomes. Subgroup analyses revealed no significant differences for BMI; the number of concomitant acute potassium-lowering therapies received; or the degree of renal impairment, aside from a significantly larger potassium-lowering effect with 10 units of intravenous regular insulin observed in the subgroup receiving no concomitant acute potassium-lowering therapies as well as the subgroup with a creatinine clearance of 30-60 mL/min.

In this small, retrospective cohort study, treatment with 5 units of intravenous regular insulin did not compromise the serum potassium-lowering effect when compared to 10 units in overweight patients with hyperkalemia. Further controlled studies are warranted to confirm these findings.