From the Research
Intravenous glucose and regular insulin therapy for hyperkalemia is typically recommended when serum potassium levels exceed 6.5 mEq/L or at lower levels (>5.5 mEq/L) if ECG changes are present or the patient is symptomatic. This recommendation is based on the most recent and highest quality study available, which emphasizes the importance of prompt treatment for hyperkalemia to prevent fatal cardiac arrhythmias and muscle paralysis 1. The standard regimen consists of 10 units of regular insulin administered intravenously along with 25 grams of glucose, which works by stimulating the sodium-potassium ATPase pump to drive potassium into cells and temporarily reduce serum potassium levels.
Some key points to consider when implementing this treatment include:
- Monitoring blood glucose before treatment and every 30-60 minutes afterward for several hours to prevent hypoglycemia, a common side effect of insulin administration
- Recognizing that this therapy is a temporary measure that redistributes potassium rather than eliminating it from the body, so additional treatments to remove excess potassium may be necessary
- Being aware that the effects of this therapy typically last 2-6 hours, and serum potassium levels may rise again after this period
It's also important to note that other studies, such as 2 and 3, support the use of insulin and glucose as a first-line treatment for hyperkalemia, but the most recent and highest quality study 1 provides the most up-to-date guidance on this topic. Overall, the goal of treatment is to rapidly reduce serum potassium levels and prevent complications, and intravenous glucose and regular insulin therapy is a key component of this approach.