Assessing the Impact of an Order Panel Utilizing Weight-Based Insulin and Standardized Monitoring of Blood Glucose for Patients With Hyperkalemia. (November 2018)

• Record Type: Journal Article
• Authors: Brown, Kelby; Setji, Tracy L.; Hale, Sarah L.; Cooper, April; Hong, Beatrice; Herbst, Rebecca; Musser, R. Clayton; Freeman, Susan; Shaikewitz, Ted; Greenlee, Jimmy; Setji, Noppon P.
• Is Part Of: American journal of medical quality. Volume 33:Number 6(2018)
• Page Start: 598
• Page End: 603
• Publication Date: 2018-11
• Subjects: hyperkalemia -- hypoglycemia -- IV insulin -- weight-based insulin; Medical care -- Quality control -- Periodicals; Medical care -- Evaluation -- Periodicals; Medical care -- Utilization review -- Periodicals; Medical care -- United States -- Periodicals; 362.1
• DOI: 10.1177/1062860618764610
• Languages: English
• ISSNs: 1062-8606

Abstract

Intravenous insulin with glucose is used in urgent treatment for hyperkalemia but has a significant risk of hypoglycemia. The authors developed an order panel within the electronic health record system that utilizes weight-based insulin dosing and standardized blood glucose monitoring to reduce hypoglycemia. As initial evaluation of this protocol, the authors retrospectively compared potassium and blood glucose lowering in patients treated with the weight-based (0.1 units/kg) insulin order panel (n = 195) with those given insulin based on provider judgment (n = 69). Serum potassium lowering did not differ between groups and there was no relationship between dose of insulin and amount of potassium lowering. There was a difference in hypoglycemia rates between groups ( P = .049), with fewer severe hypoglycemic events in the panel (2.56%) than in the non-panel group (10.14%). These data suggest weight-based insulin dosing is equally effective for lowering serum potassium and may lower risk of severe hypoglycemia.