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8/12/24 Hyperkalemia- Dextrose for hypoglycemia being added
August 12, 2024

The hyperkalemia protocol was recently updated to include glucose checks post IV insulin administration to make sure that patients do not develop HYPOglycemia post IV insulin administration.

Dextrose PRN is being added to this orderset that has a duration set for 6 hours.  Please do NOT remove any additional Hypoglycemia orders since this medication will be removed off the profile around 6 hours later. 

During the 4 hours that the nurse is supposed to be checking POC glucose values after IV insulin administration, the nurse should NOT use sliding scale insulin to treat these values.  Patients can become hypoglycemic post IV insulin for up to 6 hours based on literature reports.  Please help guide the nurse during the first 4 hours post hyperkalemia to treat hypoglycemia and not routinely treating hyperglycemic events.

Education below is what is being provided to nursing:

POC Glucose checks POST IV Insulin administration for Hyperkalemia

During hyperkalemia treatment, many patients receive IV Regular Insulin as part of the drug therapy.

Post IV Regular Insulin administration for Hyperkalemia, POC glucose values should be checked every 30 minutes for the first four hours post insulin administration for Hyperkalemia to monitor for HYPOglycemia.

These post-IV-insulin-administration POC glucose values should NOT be treated with insulin sliding scale, but only treated if hypoglycemia occurs.  After the four hour period is complete, sliding scale insulin orders should be followed, if ordered.

If you have questions related to this email, please let me know.  

Thanks.

Jerry Robinson, Pharm.D., BCPS
Pharmacy Clinical Specialist STICU/Co-Chairperson of Medication Safety Committee

PGY 2 Critical Care Residency Director
Department of Pharmacy, Huntsville Hospital
Office: 256-265-8165 ascom: 74256
Personal Cell: 256-426-5426