How is cellular potassium uptake enhanced in the treatment of hyperkalemia (high serum potassium levels)?

Updated: Apr 09, 2020
  • Author: Eleanor Lederer, MD, FASN; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Enhance potassium uptake by cells to decrease the serum concentration. IV glucose and insulin infusions are very effective in enhancing potassium uptake. A typical regimen is 10 U of regular insulin and 50 mL of dextrose 50% in water (D50W).The onset of action is within 20-30 minutes, and the duration is variable, ranging from 2 to 6 hours. Continuous infusions of insulin and glucose-containing IV fluids can be used for prolonged effect.

IV insulin (even when administered with dextrose) can cause hypoglycemia. Patients with acute kidney injury and chronic kidney disease are especially susceptible. Measure glucose and potassium levels every 2 hours. Continue monitoring glucose levels for at least 6 hours after administering insulin-glucose. [66]

A retrospective study by Pierce et al of 149 patients with low estimated glomerular filtration rate (eGFR) who received IV insulin for hyperkalemia found no significant difference in the rate of hypoglycemia (blood glucose ≤70 mg/dL) or severe hypoglycemia (< 50 mg/dL) with 10 U versus 5 U of insulin. Rates of hypoglycemia in the 10-U and 5-U groups were 16.7% and 19.7%, respectively (P = 0.79). Rates of severe hypoglycemia were 8.9% and 7.0%, respectively (P = 0.90). [67]

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