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Iatrogenic hypoglycaemia following glucose-insulin infusions for the treatment of hyperkalaemia

Lookup NU author(s): Dr Kerri Devine, Dr Salman Razvi, Dr Richard Quinton, Dr Nicola Leech



This is the authors' accepted manuscript of an article that has been published in its final definitive form by Wiley, 2021.

For re-use rights please refer to the publisher's terms and conditions.


Objectives: To study the incidence of, and risk factors for, iatrogenic hypoglycaemia following GwI infusion in our institution. Context Hyperkalaemia is a life-threatening biochemical abnormality. Glucose-with-insulin (GwI) infusions form standard management, but risk iatrogenic hypoglycaemia (glucose ≤ 3.9mmol/L). Recently updated UK guidelines include an additional glucose infusion in patients with pre-treatment capillary blood glucose (CBG) <7.0 mmol/L.Design: Retrospective analysis of outcomes for GwI infusions prescribed for hyperkalaemia from 1st January-28th February 2019, extracted from the Newcastle-upon-Tyne Hospitals NHS Foundation Trust electronic platform (eRecord). Participants 132 patients received 228 GwI infusions for hyperkalaemia. Main outcome measures Incidence, severity and time-to-onset of hypoglycaemia.Results: Hypoglycaemia incidence was 11.8%. At least 1 hypoglycaemic episode occurred in 18.2% of patients with 6.8% having at least 1 episode of severe hypoglycaemia (<3.0 mmol/L). Most episodes (77.8%) occurred within 3 hours of treatment. Lower pre-treatment CBG(5.9 mmol/L [4.1 mmol/L - 11.2 mmol/L],; versus 7.6 mmol/L [3.7 mmol/L - 31.3 mmol/L], p = 0.000) was associated with hypoglycaemia risk. A diagnosis of type 2 diabetes and treatment for hyperkalaemia within the previous 24 hours were negatively associated.Conclusions: Within our inpatient population, around 1 in 8 GwI infusions delivered as treatment for hyperkalaemia resulted in iatrogenic hypoglycaemia. Higher pre-treatment CBG and a diagnosis of type 2 diabetes were protective, irrespective of renal function. Our findings support the immediate change to current management, either with additional glucose infusions, or by using glucose-only infusions in patients without diabetes. These approaches should be compared via a prospective randomised study.

Publication metadata

Author(s): Tee SA, Devine K, Potts A, Javaid U, Razvi S, Quinton R, Roberts G, Leech NJ

Publication type: Article

Publication status: Published

Journal: Clinical Endocrinology

Year: 2021

Volume: 94

Issue: 2

Pages: 176-182

Print publication date: 01/02/2021

Online publication date: 26/09/2020

Acceptance date: 15/09/2020

Date deposited: 01/12/2020

ISSN (print): 0300-0664

ISSN (electronic): 1365-2265

Publisher: Wiley


DOI: 10.1111/cen.14343

PubMed id: 32979855


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