What is the recommended treatment for a patient with supraventricular tachycardia (SVT) and hypokalemia using a potassium, insulin, and glucose (KIG) solution?

Clarification: KIG Solution is Not Standard Treatment for SVT with Hypokalemia

There is no evidence supporting the use of a potassium-insulin-glucose (KIG) solution for treating supraventricular tachycardia with hypokalemia. The insulin-glucose component you're referring to appears to be a misunderstanding—this combination is used for hyperkalemia management (to shift potassium intracellularly), not hypokalemia treatment in SVT patients 1, 2.

Correct Approach to SVT with Hypokalemia

Immediate Hemodynamic Assessment

• If hemodynamically unstable (hypotension, altered mental status, shock, chest pain, acute heart failure): proceed immediately to synchronized cardioversion at 50-100J without delay 3, 4, 5
• If hemodynamically stable: you have time for potassium correction and stepwise pharmacologic intervention 4, 5

Potassium Correction Protocol

• Delay adenosine or other SVT treatment if serum potassium <3.3 mEq/L to avoid life-threatening arrhythmias, cardiac arrest, or respiratory muscle weakness 3
• Administer 20-30 mEq potassium per liter of IV fluid (2/3 KCl and 1/3 KPO4) to maintain serum potassium 4-5 mEq/L 3
• Insulin should only be given WITH glucose if you're treating hyperkalemia (not hypokalemia), and this is irrelevant to your SVT patient with LOW potassium 1, 2

SVT Treatment After Potassium ≥3.3 mEq/L

For hemodynamically stable patients:

• Attempt vagal maneuvers first (modified Valsalva has 31-43% success rate) 4, 5
• If unsuccessful, give adenosine 6 mg rapid IV bolus through proximal vein with immediate saline flush (90-95% success for AVNRT/AVRT) 4, 5
• Alternative agents: IV diltiazem or verapamil (64-98% success rate) or IV beta-blockers if adenosine fails 3, 4

For hemodynamically unstable patients:

• Synchronized cardioversion immediately (essentially 100% success rate) 3, 4, 5

Critical Pitfall to Avoid

Never combine insulin with glucose in a hypokalemic patient thinking this treats hypokalemia—this combination drives potassium INTO cells and would worsen hypokalemia, potentially causing fatal arrhythmias 1, 2. The insulin-glucose combination is reserved exclusively for hyperkalemia management where you want to lower serum potassium 1, 2.