Insulin-induced Hypoglycemia after Implementing Hyperkalemia Protocol at Emergency Departments: An Updated Systematic Review

Background: Addressing the critical gap in managing hyperkalemia in emergency settings, emphasizing the balance between effective potassium reduction and hypoglycemia prevention. The findings highlight the need for standardized protocols and further research to enhance patient safety and treatment efficacy. This review aims to determine the optimal intravenous insulin dose, the necessary dextrose administration, and the appropriate timing for glucose-level monitoring to prevent hypoglycemia in adults undergoing hyperkalemia treatment in emergency departments.
Methods: A systematic review was conducted following PRISMA guidelines. Full-text articles published in English between 2016 and 2024, were selected from MEDLINE (PubMed), Science Direct, CINAHL, Cochrane Database, and Google Scholar. The inclusion criteria comprised studies involving adult patients treated for hyperkalemia in emergency departments, focusing on insulin and dextrose administration protocols. The review was registered on PROSPERO (CRD42023399719). Data extraction and synthesis involved assessing study quality, insulin doses, dextrose administration, and timing of glucose monitoring.
Results: The review included 16 studies, with 11 patients involving renal disease. Hyperkalemia was defined by 12 studies (75%) as a potassium level exceeding 5 mmol/L. The prevalence of hypoglycemia ranged from 15-20%. There was variability in the initial glucose monitoring time post-insulin administration, with 10 studies (63%) opting for a 6-hour mark. The most reported insulin dose to prevent hypoglycemia was 5-10 units. Additionally, 50% of the studies recommended administering 25 g of dextrose (D50%) to prevent hypoglycemia.
Conclusions: Although optimized insulin therapy regimens have shown promise in reducing hypoglycemia risk, effective management of potassium levels remains a challenge. Future research must inform treatment guidelines and clinical practice, ensuring safer and more effective care for hyperkalemia patients.