2025 Southeastern Residency Conference

Title: Safety and Efficacy of Alternative Insulin Dosing Strategies for the Management of Hyperkalemia


Authors: Savannah Small, Amanda Guffey, Erik Turgeon


Background: Hyperkalemia is a common electrolyte disorder that can lead to serious complications, and potentially life threatening cardiac arrythmias, if not managed appropriately. IV regular insulin is typically used in combination with other treatment strategies for the management of acute hyperkalemia due to its quick onset and modest duration. Current guidelines recommend administering insulin as an IV bolus of 10 units, typically in combination with 25-50g of dextrose to mitigate the risk of hypoglycemia. Despite coadministration with dextrose, 10 units of IV regular insulin given for the treatment of hyperkalemia, has been associated with significant rates of hypoglycemia. Some evidence suggests a lower incidence of hypoglycemia with comparable potassium lowering when utilizing 5 units as an IV bolus compared to 10 units of IV regular insulin.


Methods: Pre- and post-intervention chart review of hospital-wide hyperkalemia treatment encounters at a single-center, 607-bed teaching hospital in West Columbia, SC from October 2023 to April 2025. The intervention of this study is the modification of current hyperkalemia order sets from a default IV regular insulin dose of 10 units to a default of 5 units. This review will be utilized to compare the safety and efficacy of IV regular insulin administered at 5 units vs 10 units. The primary outcome is the incidence of clinically significant hypoglycemic events, defined as a blood glucose level less than 70 mg/dL, associated with IV insulin administration for the treatment of hyperkalemia. Secondary outcomes include potassium lowering effects of each IV insulin dosing strategy for the treatment of hyperkalemia and any relevant severe hypoglycemic events, defined as blood glucose levels less than 40 mg/dL. Hypoglycemic events and change in serum potassium levels were manually analyzed by the investigator through EHR-generated data and manual chart review.


Results: In progress.
Conclusion: In Progress.