From the Guidelines
D-50 (50% dextrose) is not a recommended treatment for hyperkalemia, as the most recent and highest quality studies do not support its use as a primary treatment for hyperkalemia. According to the most recent study 1, the treatment options for acute hyperkalemia include intravenous calcium gluconate, insulin/glucose, inhaled β-agonists, intravenous sodium bicarbonate, and hemodialysis.
The use of insulin and glucose to treat hyperkalemia is supported by the literature 1, as it helps to redistribute potassium into the cells, thereby lowering serum potassium levels. The recommended dose of insulin is typically 10 units of regular insulin, administered intravenously, along with glucose to prevent hypoglycemia.
It's essential to note that the treatment of hyperkalemia should be individualized, taking into account the severity of the condition, the presence of any underlying medical conditions, and the patient's overall health status. A comprehensive approach to hyperkalemia management may include cardiac membrane stabilization with calcium gluconate, as well as other potassium-lowering strategies, such as loop diuretics, potassium binders, or hemodialysis, as needed.
In terms of specific treatment protocols, the European Heart Journal study 1 provides a detailed table outlining the various treatment options for acute and chronic hyperkalemia, including the use of β2-adrenergic agonists, insulin, sodium bicarbonate, and calcium chloride or gluconate. However, D-50 is not mentioned as a recommended treatment option in this study or in the other provided studies.
Therefore, based on the most recent and highest quality evidence, the use of D-50 (50% dextrose) is not recommended as a primary treatment for hyperkalemia, and instead, other evidence-based treatments should be considered.
From the Research
Treatment for Hyperkalemia
- The treatment for hyperkalemia typically involves stabilizing cardiac membranes, shifting potassium into cells, and removing excess potassium from the body 2, 3, 4, 5.
- Calcium gluconate is often used to stabilize cardiomyocyte membranes, followed by insulin injection and beta-agonists administration 2.
- Insulin and glucose are frequently used to manage patients with hyperkalemia, with the goal of shifting potassium into cells 6.
- Dextrose 50% (D50) is commonly administered with insulin to manage hyperkalemia, but the risk of hypoglycemia should be considered and monitored 6.
- Strategies to reduce the risk of hypoglycemia with insulin therapy include using lower doses of insulin, administering D50 instead of lower doses of dextrose, and monitoring patients for hypoglycemia hourly for at least 4-6 hours after administration 6.
Management of Hyperkalemia
- The management of hyperkalemia depends on the underlying cause and severity of the condition 2, 3, 4, 5.
- Acute hyperkalemia requires immediate attention and treatment to prevent life-threatening complications 2, 4, 5.
- Chronic hyperkalemia is associated with increased morbidity and mortality, and treatment should focus on correcting underlying causes and managing potassium levels 4.
- Medications such as potassium-binding drugs and sodium-glucose cotransporter 2 inhibitors can be used to assist in managing hyperkalemia 4.