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Lookup NU author(s): Dr Kerri Devine,
Dr Salman RazviORCiD,
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.
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
Print publication date: 01/02/2021
Online publication date: 26/09/2020
Acceptance date: 30/09/2020
Date deposited: 01/12/2020
ISSN (print): 0300-0664
ISSN (electronic): 1365-2265
PubMed id: 32979855
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