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The Effect of Patient Factors and Cotreatments on the Magnitude of Potassium Lowering with Insulin–Glucose Treatment in Patients with Hyperkalemia

1
Department of General Medicine, Monash Health, Clayton, VIC 3168, Australia
2
Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC 3168, Australia
*
Author to whom correspondence should be addressed.
Received: 30 November 2020 / Revised: 4 January 2021 / Accepted: 5 January 2021 / Published: 11 January 2021
The management of hyperkalemia with insulin–glucose/dextrose treatment (IDT) may be influenced by patient factors and cotreatments. We aimed to determine the magnitude of potassium lowering by IDT while considering patient factors and cotreatments. We observed the change in serum potassium in 410 patients with a mean serum potassium of 6.6 mmol/L (SD, 0.6 mmol/L) treated with IDT at three major metropolitan hospitals. Mean potassium lowering was 1.4 mmol/L (SD, 0.8 mmol/L) and 53% achieved normokalemia. Cotreatment with sodium polystyrene sulfonate, salbutamol, or sodium bicarbonate occurred in 64%, 12%, and 10% of patients, respectively. In multiple linear regression analysis, cotreatment with sodium polystyrene sulfonate or sodium bicarbonate was not associated with any significant reduction in serum potassium beyond that achieved by IDT, within the initial 6 h of treatment. We observed an additional lowering of serum potassium with salbutamol of 0.3 mmol/L (95% CI: 0.1 to 0.6 mmol/L; p = 0.009) but the clinical significance was unclear as the proportion of patients achieving normokalemia was not affected by cotreatment within the initial 6 h after IDT. We also found evidence that the potassium-lowering effect of IDT was dependent on the pre-treatment serum potassium. For every 1 mmol/L increase in pre-treatment serum potassium over 6.0 mmol/L, there was an associated 0.7 mmol/L increase in the potassium-lowering effect of IDT, on average, which was independent of any cotreatment. There was no significant impact of acute kidney injury or chronic kidney disease status on the efficacy of IDT. View Full-Text
Keywords: potassium; hyperkalemia; insulin–dextrose; insulin–glucose; sodium polystyrene sulfonate; salbutamol; sodium bicarbonate; chronic kidney disease; acute kidney injury; dialysis potassium; hyperkalemia; insulin–dextrose; insulin–glucose; sodium polystyrene sulfonate; salbutamol; sodium bicarbonate; chronic kidney disease; acute kidney injury; dialysis
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MDPI and ACS Style

Lim, A.K.H.; Crnobrnja, L.; Metlapalli, M.; Govinna, M.; Jiang, C. The Effect of Patient Factors and Cotreatments on the Magnitude of Potassium Lowering with Insulin–Glucose Treatment in Patients with Hyperkalemia. Epidemiologia 2021, 2, 27-35. https://0-doi-org.brum.beds.ac.uk/10.3390/epidemiologia2010003

AMA Style

Lim AKH, Crnobrnja L, Metlapalli M, Govinna M, Jiang C. The Effect of Patient Factors and Cotreatments on the Magnitude of Potassium Lowering with Insulin–Glucose Treatment in Patients with Hyperkalemia. Epidemiologia. 2021; 2(1):27-35. https://0-doi-org.brum.beds.ac.uk/10.3390/epidemiologia2010003

Chicago/Turabian Style

Lim, Andy K.H., Ljiljana Crnobrnja, Manogna Metlapalli, Mauli Govinna, and Cathy Jiang. 2021. "The Effect of Patient Factors and Cotreatments on the Magnitude of Potassium Lowering with Insulin–Glucose Treatment in Patients with Hyperkalemia" Epidemiologia 2, no. 1: 27-35. https://0-doi-org.brum.beds.ac.uk/10.3390/epidemiologia2010003

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