Preventing Hypoglycemia Following Treatment of Hyperkalemia in Hospitalized Patients
Hypoglycemia is a serious complication following treatment of hyperkalemia with intravenous insulin. The aims of this study were to determine the incidence of hypoglycemia (≤3.9 mmol/l, 70 mg/dL) and severe hypoglycemia (<3.0 mmol/l, 54 mg/dL) in noncritical care inpatients following treatment of hyperkalemia and to establish the risk factors predisposing to this complication. This was a single-center observational study reviewing the Electronic Patient Records of hyperkalemia treatment with intravenous insulin on the general wards of a large UK teaching hospital. A total of 662 episodes of hyperkalemia treated with insulin/dextrose were included. Among these episodes, 116 treatments (17.5%) resulted in hypoglycemia and 47 (7.1%) resulted in severe hypoglycemia. Lower pretreatment capillary blood glucose level, older age, and lower bodyweight were associated with a higher risk of posttreatment hypoglycemia. The incidence of hypoglycemia following hyperkalemia treatment in hospitalized patients is unacceptably high. Identifying individuals at high risk of hypoglycemia and adjusting prescriptions may reduce the incidence.
© 2019 Society of Hospital Medicine
FUTURE WORK
An increasing proportion of hospitals are utilizing Electronic Prescribing Systems with the potential to improve patient safety by standardizing prescriptions. However, despite standardized prescriptions, 37% of prescriptions for concurrent dextrose were not administered with insulin and 8.6% of patients had no CBG monitoring within six hours after insulin administration.
We propose to integrate the risk factors identified in this study into a decision support tool embedded within electronic prescriptions and medication administration. This will auto-populate with data from the EPR and identify individuals at high risk of hypoglycemia following hyperkalemia treatment. The decision support tool will then advise a prescription with a higher volume of dextrose and/or lower insulin dose to mitigate this risk.
CONCLUSION
Hyperkalemia treatment with insulin was associated with high incidence of hypoglycemia. Decision support tools highlighting individuals at high risk of hypoglycemia may reduce this incidence.
Disclosures
The authors have nothing to disclose.
