hyperkalemia tx of insulin and glucose?

[erin01]

Hi,

I just need someone to explain the science behind this again. I had a pt who had a k+6 and needed this treatment. I have asked my my superiors before and i was told its a common tx. I was also told insulin can be iv or sq? any thoughts.... and research. This tx always make me nervous as bld sugar can go up and down. thanks

[emtb2rn, BSN, RN, EMT-B]

IV glucose (1/2-full amp) then IV insulin will result in the insulin pulling the glucose into the body's cells along with that pesky K. Faster than kayexalate.

[Reno1978, BSN, RN]

Basically, potassium follows glucose into cells with the insulin administration. The D50 is given to prevent hypoglycemia. In my experience, the insulin is given IV. After time, the potassium will leak back out of the cells, so K should be monitored at least every 4 hours until it's remains normal.

[poopyhead]

I think this link might help u answer ur question.. http://emedicine.medscape.com/article/766479-overview.

cheers!!

[actioncat]

My understanding is that this is a more immediate treatment than kayexalate, but is often followed up with kayexalate for more lasting results.

[OutlawNurse86, BSN, RN]

Just a few months ago I had a pt with a 6.9 K+, called the Doc, told me to give 10 units of Regular insulin IV followed by an Amp of D50, then give 1G of Calcium Gluconate IVPB. Also to do a stat Albuterol tx (the respiratory therapist had some interesting words for this one, apparently the theory is that 2 albuterol tx back to back should work somehow, but noone I've talked to has ever seen it work). Also.... I had admitted this guy from the ED the previous night. They had given him 30G of Kayexelate, I later had to give him 60G (yes a total of 90G of Kayexelate).....the guy didn't even pass gas!

Oh....and to top it off..... right as I was reporting off to the other shift...... dialysis was here to pick him up....he developed chest pain..... So add 3 doses of SL Nitro to all that too.

Also, the IV insulin is only a temporary fix (forgot to add that)

[XingtheBBB, BSN, RN]

We always give the triple treatment- 10 units Insulin + D50 to balance the insulin + an amp of Calcium gluconate. Often we add Bicarb, too. (shifts K back into cells if acidosis has shifted it out. Many of our ICU patients already are on the acidotic side)

Somewhere I had notes from our intensivists about why they often prefer Ca gluconate vs chloride but either can be given. I can't find them in my brain book, though. The Ca does not decrease K but buffers its effect on cardiac muscle.

Add the Kayexolate to bind the K when the cells re-release it.

I think that Beta-2 agonists like albuterol are supposed to push K into cells, too, but I've never seen it tried. Seems to me like a Beta-2 push might add to cardiac irritability even as it lowers K? I'd like to understand this better... guess I have some homework tonight!

[AlabamaBelle]

Yes, this is a common method to get K down quickly. I work in Peds and we have done this with hyperkalemic patients. It does require frequent labs afterward, but it does get K down quickly.