The Breach - By Barrie Stevenson - January 7, 2020
"Problem 1: Too much insulin
Take home points
- Treating hyperkalaemia with insulin will cause blood glucose levels to fall, even if you co-administer dextrose
- The drop in blood glucose is highly variable, but may be as much as 2.9mmol/L (53mg/dL)
- The effects of IV dextrose will wear off before those of insulin, so check blood glucose after 1-2 hours
Problem 2: Too little calcium
Take home points
- Use 10% calcium gluconate unless you have a central line. Give 3 sequential doses of 10ml until the ECG normalises
- Only give calcium if there are ECG changes associated with hyperkalaemia
- The duration of action is 30-60min, so be ready to repeat the dose if ECG changes reappear"