From the Guidelines
I would give D50 to a patient who has received 10 units of lispro insulin for hyperkalemia and hyperglycemia to prevent hypoglycemia. When insulin is administered to treat hyperkalemia, it works by shifting potassium from the bloodstream into cells, but it also lowers blood glucose levels. Even though the patient initially has high blood sugar, 10 units of rapid-acting insulin (lispro) can cause blood glucose to drop precipitously. According to the 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1, glucose plus insulin can be administered to manage hyperkalemia, with a recommended dose of 25 g (50 mL of D50) glucose and 10 U regular insulin given IV over 15 to 30 minutes. Key points to consider when administering D50 in this context include:
- D50 is typically administered as 25-50 mL (containing 12.5-25 grams of dextrose) intravenously to counteract the insulin-induced glucose drop.
- The insulin-glucose combination therapy is effective because insulin's action on potassium transport occurs independently of its glucose-lowering effects.
- After administration, blood glucose levels should be monitored frequently (every 30-60 minutes initially) to ensure they remain in a safe range. This approach allows the insulin to perform its intended function of lowering serum potassium while preventing the dangerous complication of hypoglycemia.
From the FDA Drug Label
Excess insulin administration may cause hypoglycemia and hypokalemia. More severe episodes with coma, seizure, or neurologic impairment may be treated with ... concentrated intravenous glucose.
You would give D50 (concentrated intravenous glucose) to treat severe hypoglycemia that may occur due to excess insulin administration from the 10 units of lispro, especially since the patient already has high potassium (hypokalemia is a concern with insulin overdose, but in this case, the patient has hyperkalemia) and high blood sugar. The high blood sugar indicates that the insulin is needed, but the risk of hypoglycemia due to insulin overdose necessitates caution and preparedness to treat it with D50 if necessary 2.
From the Research
Administration of D50 in Hyperkalemia Treatment
- The administration of D50 (dextrose 50%) is a common practice in the treatment of hyperkalemia, especially when insulin is used to help lower potassium levels 3, 4, 5.
- In the context of high blood sugar, giving 10 units of lispro (a type of insulin) may lead to hypoglycemia, and D50 is administered to prevent or treat this condition 3, 4, 5.
- Studies have shown that the use of D50 can help prevent hypoglycemia in patients with hyperkalemia who are receiving insulin therapy 3, 4, 5.
- However, the optimal dose and administration method of dextrose are still debated, with some studies suggesting that a prolonged infusion of dextrose 10% may be as effective as a D50 bolus in preventing hypoglycemia 3.
Considerations for D50 Administration
- The decision to administer D50 should take into account the patient's initial blood glucose level, as low initial levels may increase the risk of hypoglycemia 4, 5.
- Patients with diabetes or those who are at risk of hypoglycemia may require closer monitoring and adjusted treatment strategies 5, 6.
- The use of a standardized treatment panel, which includes guidelines for insulin dosing and blood glucose monitoring, may help reduce the risk of hypoglycemic events in patients with hyperkalemia 6.
Special Considerations
- In patients with combined aldosterone and insulin deficiency, glucose administration may lead to hyperkalemia, and alternative treatment strategies may be necessary 7.
- The presence of other underlying conditions, such as renal dysfunction or diabetes, should be taken into account when administering D50 and insulin for hyperkalemia treatment 4, 5, 6.