• Nathaniel L Scott, Lauren R Klein, Ellen Cales, and Brian E Driver.
• Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, United States; Department of Internal Medicine, Hennepin County Medical Center, Minneapolis, MN, United States. Electronic address: nathaniel.scott@hcmed.org.
• Am J Emerg Med. 2019 Feb 1; 37 (2): 209-213.

IntroductionComplications associated with the emergency department (ED) management of hyperkalemia are not well characterized. The goals of this study were to describe the frequency of hypoglycemia following the use of insulin to shift potassium intracellularly and to examine the association of key variables with this complication.MethodsAdult ED patients (≥18 years old) with hyperkalemia (>5.3 mmol/L) were identified in the electronic medical record over a 5-year period at the study site. Patient characteristics, laboratory results, and treatments in the ED were captured. A generalized estimating equation (GEE) model was utilized to determine independent associations with the development of hypoglycemia.Results1307 encounters were identified where hyperkalemia was present. Hypoglycemia (defined as a glucose <70 mg/dL) occurred in 68/409 (17%) of patients given insulin, compared to 4% of patients who did not receive insulin. Lower glucose prior to insulin (adjusted odds ratio [aOR] 0.90; 95% confidence interval [95% CI] 0.85 to 0.96), higher doses of insulin (aOR 1.07; 95% CI 1.01 to 1.15) and lower doses of D50 (aOR 0.98; 95% CI 0.97 to 0.99) were independently associated with hypoglycemia in the multivariate analysis. Age, history of diabetes, and history renal failure were not independently associated.ConclusionHypoglycemia is a frequent complication of treatment with IV insulin in the ED. Interventions such as standardized protocols to assist with the ED management of hyperkalemia should be developed; their efficacy and safety should be compared.Copyright © 2018 Elsevier Inc. All rights reserved.

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