No. One. Dies. From. A. Potassium. Of. 5.6.
But there is morbidity from the insulin glucose antidote.
These guys from Rush University Medical Center looked at the risk of hypoglycemia from the standard 10 units of insulin followed by 25 grams of glucose. They found 13% of ESRD patients developed a glucose south of 60 mg/dl.
Remember the kidney both metabolizes insulin and is a source gluconeogenesis, so dialysis patients are naturally more prone to hypoglycemia.
|Love me some table one.|
Similar data was found in a study by Schafers. Schafers followed that study with this one, which suggests that weight based insulin dosing 0.1 units/kg up to 10 units could reduce hypoglycemia by about half:
What is truly terrifying is if some people start trying to really drive the potassium down with Sterns' recommendations from KI:
Sterns suggests 6u bolus f/b 20u/hour insulin + 60 g glucose/hour for acute hyperkalemia in KI review https://t.co/vUTgibCyxE— Swapnil Hiremath, MD (@hswapnil) April 14, 2016
|Systemic effects of formoterol and salmeterol: a dose-response comparison in healthy subjects|
Let's be careful out there and stop treating inconsequential hyperkalemia, let's save our toxic antidote for truly toxic potassiums.
At what potassium would you give insulin + glucose?— Joel Topf, MD FACP (@kidney_boy) December 6, 2016