Weight‐based insulin dosing for acute hyperkalemia results in less hypoglycemia

Hyperkalemia treatment with intravenous insulin has been associated with hypoglycemia. This single‐center, retrospective study compared the effects on hypoglycemia between weight‐based insulin dosing (0.1 U/kg of body weight up to a maximum of 10 U) compared to standard flat doses of 10 U among patients weighing less than 95 kg. Of the 132 charts randomly selected for review, hypoglycemic events (blood glucose <70 mg/dL) were reduced from 27.3% in the 10‐U group to 12.1% in the weight‐based group ( P = 0.05). The number of affected patients was reduced with 19.7% in the 10‐U group and 10.6% in the weight‐based group ( P = 0.22). The potassium‐lowering effects of these 2 strategies were similar between groups. Female patients and those with baseline glucose values <140 mg/dL were at increased risk for hypoglycemia. Weight‐based insulin dosing (0.1 U/kg) for acute hyperkalemia therapy resulted in less hypoglycemia without impacting potassium lowering. Journal of Hospital Medicine 2016;11:355–357. © 2016 Society of Hospital Medicine