The estimated incidence of hypoglycemia ranges from 6 to 21% 3, 4, 5, 6. IDT can be complicated by hypoglycemia, which is associated with increased morbidity and mortality. Insulin stimulates the activity of the sodium-hydrogen antiporter on cell membranes, and via promoting sodium entry into cells, triggers activation of the sodium–potassium ATPase pump leading to potassium influx into cells 1. Unlike oral cation exchange resins which require several hours to reduce serum potassium through the gastrointestinal tract, intravenous (IV) insulin rapidly shifts potassium intracellularly 2. Insulin-dextrose treatment (IDT) is a common first-line treatment for moderate (potassium 6 to 7 mmol/L) to severe hyperkalemia (potassium > 7 mmol/L). Serum potassium levels above 6 mmol/L require urgent treatment to avoid cardiac instability 1, 2. Hyperkalemia is associated with the risk of cardiac arrhythmia and cardiac arrest. Understanding the factors associated with hypoglycemia and the critical window of risk is essential for the development of preventive strategies. Hypoglycemia occurred most frequently between 60 and 150 min, with a peak at 90 min. The prevalence of diabetes was 60%, and 70% had chronic kidney disease (eGFR < 60 ml/min/1.73 m 2).

The mean age was 70 years with 62% male predominance. 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. 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. Treatment of hyperkalemia with intravenous insulin-dextrose is associated with a risk of hypoglycemia.

Icd 10 code for hyperkalemia