Hypoglycemia in the Treatment of HyperKalemia

General EM PGY1 PGY2 PGY3 PGY4

Hypoglycemia in the treatment of hyperkalemia in ESRD frequently happens! There ae growing in the body of literature to address this issue with different recommendations:

  1. administering 25 g of dextrose with insulin and 25 g of dextrose 1 h after insulin based on our result that hypoglycemia occurred 1–3 h after insulin with dextrose. Link to article
  2. The dextrose may be administered as 100 ml of 50% dextrose IVP or 50 ml of 50% dextrose IVPB, followed by 250 ml of
    D10 IVPB over 1 hour. Link to article
  3. ISMP Medication Safety Alert



Argument for Low dose vs high dose Insulin induced hypoglycemia in the management of hyperkalemia

Link to weight based Insulin?

Link to No difference