The Association of Insulin-dextrose Treatment with Hypoglycemia in Patients with Hyperkalemia

Abstract Treatment of hyperkalemia with intravenous insulin-dextrose is associated with a risk of hypoglycemia. We aimed to determine the factors associated with hypoglycemia (glucose < 3.9 mmol/L, or < 70 mg/dL) and the critical time window with the highest incidence. In a retrospective cohor...

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Autores principales:	Ljiljana Crnobrnja, Manogna Metlapalli, Cathy Jiang, Mauli Govinna, Andy K. H. Lim
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2020
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/0fa92cf6cc11486cab1bbc645a32a5f3
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spelling	oai:doaj.org-article:0fa92cf6cc11486cab1bbc645a32a5f32021-12-02T11:57:56ZThe Association of Insulin-dextrose Treatment with Hypoglycemia in Patients with Hyperkalemia10.1038/s41598-020-79180-72045-2322https://doaj.org/article/0fa92cf6cc11486cab1bbc645a32a5f32020-12-01T00:00:00Zhttps://doi.org/10.1038/s41598-020-79180-7https://doaj.org/toc/2045-2322Abstract Treatment of hyperkalemia with intravenous insulin-dextrose is associated with a risk of hypoglycemia. We aimed to determine the factors associated with hypoglycemia (glucose < 3.9 mmol/L, or < 70 mg/dL) and the critical time window with the highest incidence. In a retrospective cohort study in a tertiary hospital network, we included 421 adult patients with a serum potassium ≥ 6.0 mmol/L who received insulin-dextrose treatment. The mean age was 70 years with 62% male predominance. The prevalence of diabetes was 60%, and 70% had chronic kidney disease (eGFR < 60 ml/min/1.73 m2). The incidence of hypoglycemia was 21%. In a multivariable logistic regression model, the factors independently associated with hypoglycemia were: body mass index (per 5 kg/m2, OR 0.85, 95% CI: 0.69–0.99, P = 0.04), eGFR < 60 mL/min/1.73 m2 (OR 2.47, 95% CI: 1.32–4.63, P = 0.005), diabetes (OR 0.57, 95% CI 0.33–0.98, P = 0.043), pre-treatment blood glucose (OR 0.84, 95% CI: 0.77–0.91, P < 0.001), and treatment in the emergency department compared to other locations (OR 2.53, 95% CI: 1.49–4.31, P = 0.001). Hypoglycemia occurred most frequently between 60 and 150 min, with a peak at 90 min. Understanding the factors associated with hypoglycemia and the critical window of risk is essential for the development of preventive strategies.Ljiljana CrnobrnjaManogna MetlapalliCathy JiangMauli GovinnaAndy K. H. LimNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 10, Iss 1, Pp 1-9 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Ljiljana Crnobrnja Manogna Metlapalli Cathy Jiang Mauli Govinna Andy K. H. Lim The Association of Insulin-dextrose Treatment with Hypoglycemia in Patients with Hyperkalemia
description	Abstract Treatment of hyperkalemia with intravenous insulin-dextrose is associated with a risk of hypoglycemia. We aimed to determine the factors associated with hypoglycemia (glucose < 3.9 mmol/L, or < 70 mg/dL) and the critical time window with the highest incidence. In a retrospective cohort study in a tertiary hospital network, we included 421 adult patients with a serum potassium ≥ 6.0 mmol/L who received insulin-dextrose treatment. The mean age was 70 years with 62% male predominance. The prevalence of diabetes was 60%, and 70% had chronic kidney disease (eGFR < 60 ml/min/1.73 m2). The incidence of hypoglycemia was 21%. In a multivariable logistic regression model, the factors independently associated with hypoglycemia were: body mass index (per 5 kg/m2, OR 0.85, 95% CI: 0.69–0.99, P = 0.04), eGFR < 60 mL/min/1.73 m2 (OR 2.47, 95% CI: 1.32–4.63, P = 0.005), diabetes (OR 0.57, 95% CI 0.33–0.98, P = 0.043), pre-treatment blood glucose (OR 0.84, 95% CI: 0.77–0.91, P < 0.001), and treatment in the emergency department compared to other locations (OR 2.53, 95% CI: 1.49–4.31, P = 0.001). Hypoglycemia occurred most frequently between 60 and 150 min, with a peak at 90 min. Understanding the factors associated with hypoglycemia and the critical window of risk is essential for the development of preventive strategies.
format	article
author	Ljiljana Crnobrnja Manogna Metlapalli Cathy Jiang Mauli Govinna Andy K. H. Lim
author_facet	Ljiljana Crnobrnja Manogna Metlapalli Cathy Jiang Mauli Govinna Andy K. H. Lim
author_sort	Ljiljana Crnobrnja
title	The Association of Insulin-dextrose Treatment with Hypoglycemia in Patients with Hyperkalemia
title_short	The Association of Insulin-dextrose Treatment with Hypoglycemia in Patients with Hyperkalemia
title_full	The Association of Insulin-dextrose Treatment with Hypoglycemia in Patients with Hyperkalemia
title_fullStr	The Association of Insulin-dextrose Treatment with Hypoglycemia in Patients with Hyperkalemia
title_full_unstemmed	The Association of Insulin-dextrose Treatment with Hypoglycemia in Patients with Hyperkalemia
title_sort	association of insulin-dextrose treatment with hypoglycemia in patients with hyperkalemia
publisher	Nature Portfolio
publishDate	2020
url	https://doaj.org/article/0fa92cf6cc11486cab1bbc645a32a5f3
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The Association of Insulin-dextrose Treatment with Hypoglycemia in Patients with Hyperkalemia

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