Insulin during cardiac arrest?

[kimmie518]

Last semester my instructor mentioned (off the books) that insulin is sometimes given during cardiac arrest. I forgot what she mentioned the action of this was, and I can't seem to find any information pertaining to it. Does anyone have any insight?

[delta32]

Hi Kimmie,

I have been an ICU nurse for 4 years in the capital district. I have never push insulin during a Code. I am not sure what she may be talking about. It may be a strech but is she talking about treating a patient with high K level during a code? I really have no idea. I am ACLS certified and have not heard of this. It sounds like she is trying to treat a "cause"..aka the high potassium level. Please feel free to contact me via private message if you have questions.

Jamie

[AnnieOaklyRN, BSN, RN, EMT-P]

I have never heard of this either. maybe she ment D50 instead. High K would be treated with calcium or bicarb.

Swtooth

[EricJRN, MSN, RN]

Check out this link. This involves giving a combination of glucose and insulin to rats in asphyxial cardiac arrest. Apparently the combination (but neither glucose nor insulin alone) improved neuro outcomes. Couldn't find any human studies or anything on the specific mechanism.

http://cat.inist.fr/?aModele=afficheN&cpsidt=1794861

[NicoleRN07, RN]

I have never given insulin during a code, but I have given it many times for increased K. I can not see that this would have an immediate effect during life saving measures.

[kimmie518]

Thanks for the info.

I'll have to email my instructor to see what she said. I'm very curious.

[cardsRN]

i have treated high k with insulin and d50 iv push before, but personally, not in an arrest. maybe that's what she was talking about.

[sirI, MSN, APRN, NP]

AHA:

Table 3. Emergency Treatment of Hyperkalemia*

Therapy ... Dose ..Mechanism of Effect ..Onset of Effect ..Duration of Effect

Therapy: Calcium chloride .. Dose: 5-10 mL IV of 10% solution (50-100 mg) ..Mechanism of Effect: Antagonize .. Onset: 1-3 min .. Duration: 30-60 min

Therapy: Sodium bicarbonate... Dose: 1 mEq/kg IV bolus ... Mechanism: Shifts ... Onset: 5-10 min .. Duration: 1-2 h

Therapy: Insulin plus glucose .. Dose: (use 1 U insulin/5 g glucose) Regular insulin 10 U IV plus 50 g glucose ... Mechanism: Shifts ... Onset: 30 min .. Duration: 4-6 h

Therapy: Diuresis with furosemide .. Dose: 40-80 mg IV bolus ... Mechanism: Removes ... Onset; When diuresis starts ... Duration: When diuresis ends

Therapy: Cation-exchange resin .. Dose: 15-50 g PO or PR plus sorbitol ... Mechanism: Removes .. Onset; 1-2 h .. Duration: 4-6 h

Therapy: Peritoneal dialysis or hemodialysis ... Dose: Per institution ... Mechanism: Removes ...Onset: As soon as started ... Duration: Until dialysis completed

http://www.americanheart.org/presenter.jhtml?identifier=1747

Rationale for IV glucose/insulin: Glucose and insulin shifts potassium from the extracellular fluids back into the cells. This may reverse severe symptoms long enough to allow correction of the etiology of the hyperkalemia.

Excellent article from eMedicine:

http://www.emedicine.com/emerg/topic261.htm

[scalpel179]

I recently heard a researcher at my school discuss the benefits of infusing a solution containing glucose, insulin, and potassium. Without going into all the details, this is basically cellular food for metabolism. Cellular death occurs during a typical cardiac arrest.

[tridil2000, MSN, RN]

I recently heard a researcher at my school discuss the benefits of infusing a solution containing glucose, insulin, and potassium. Without going into all the details, this is basically cellular food for metabolism. Cellular death occurs during a typical cardiac arrest.

you can tell that researcher that O2, and getting the O2 into the coronaries and brain is paramount, and cellular death occurs after 4 minutes without it.

[CrazyScrubNurse, BSN, RN]

Hey you might want to clarify with your instructor. Was this a cardiac patient or is it a diabetic ketoacidosis crisis patient question? Maybe the insulin was already running on a pump, and they went into arrest because they didn't replace the K+ quickly enough.

[rgroyer1RNBSN, BSN, RN]

You might want to add in there to we also use Kaexylate for hyperkalemia