Insulin and Dextrose for Hyperkalemia: Clinical Guide, Protocols, and Safety Pearls
Clnical Pearl
Kevin Van, PharmD, BCPS (Editor)
2 min read
Insulin and Dextrose for Hyperkalemia: Clinical Guide, Protocols, and Safety Pearls
Learn the evidence-based use of IV regular insulin with dextrose for acute hyperkalemia management. Includes dosing, timing, when to use D50W vs D5W, and hypoglycemia prevention.
On this page
Insulin + Dextrose for Hyperkalemia Management
Mechanism:
IV regular insulin shifts potassium into cells via Na⁺/K⁺-ATPase activation. Dextrose prevents insulin-induced hypoglycemia. This is a temporizing measure until potassium is removed from the body (dialysis, binders, diuretics).
Recommended Regimen
- Regular Insulin (IV bolus): Dilute 10 units in 50 mL 0.9% sodium chloride (normal saline) over 5 minutes.
- Dextrose (IV push): 25 g IV (50 mL of D50W), given concurrently or immediately after insulin.
- Onset: 15–30 min | Duration: 4–6 hr | K⁺ reduction: ~0.6–1.2 mmol/L
When to Use D50W vs. D5W
- D50W IV push (preferred): Standard to pair with insulin. Rapid onset, small volume, prevents immediate hypoglycemia.
- D5W infusion: Not a substitute for the bolus. Useful only for ongoing glucose support in high-risk patients (e.g., NPO, renal failure).
- Practical strategy: Use D50W bolus up front, then consider D10W or D5W infusion if prolonged supplementation is needed.
Monitoring & Safety
- Check blood glucose every 30–60 minutes for at least 4–6 hours.
- Hold dextrose if baseline glucose >250 mg/dL.
- Watch for rebound hyperkalemia as effect is temporary.
- Hypoglycemia risk is highest in patients with renal dysfunction.
https://info.pharkeep.com/insulin-and-dextrose-for-hyperkalemia.html
Related Article
Rapid vs. Fast-Acting Insulin: Clinical Differences and Perioperative Use
Understand the key differences between rapid-acting insulin analogs and fast-acting regular insulin. Learn when to use each, including perioperative management, meal-time dosing, correctional therapy, and inpatient IV insulin use.
Kevin Van, PharmD, BCPS (Editor)
References
- https://www.ahajournals.org/doi/10.1161/CIR.0000000000000916
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6488184/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7142711/
- https://www.acep.org/clinical/clinical-policies/
- https://journals.lww.com/em-news/fulltext/2019/04000/dextrose_administration_strategies_for.15.aspx
- https://www.kidney-international.org/article/S0085-2538(19)30090-7/fulltext
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5555466/
- https://www.ajkd.org/article/S0272-6386(16)30072-1/fulltext
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6139912/
- https://www.tandfonline.com/doi/full/10.1080/10903127.2018.1484966
- https://www.nejm.org/doi/10.1056/NEJMra1716026
- https://www.nature.com/articles/s41581-019-0192-3
- https://physiology.org/doi/10.1152/ajprenal.00417.2018
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4821121/
- https://onlinelibrary.wiley.com/doi/10.1111/acem.13666