insulin and glucose in the treatment of hyperkalaemia

Last reviewed 01/2018

Adult dose:

• 10u of soluble insulin (eg actrapid) with 50mls of 50% glucose (ie 25g) given over 15 minutes.

Insulin stimulates the Na+-K+ ATPase pump in skeletal muscle, cardiac muscle and liver so driving potassium into cells. Serum potassium concentration is therefore lowered. Simultaneous administration of glucose is necessary in order to prevent hypoglycaemia.

Effects should be apparent within 30-60 minutes and should last for 4-6 hours. Insulin produces only a temporary reduction in serum potassium. It does not remove K+ from the body. It may be necessary to repeat administration or continue infusion at a ratio of 3-4g of glucose to each unit of insulin. Titrate against serum potassium and glucose.

CAUTION IN DIABETIC PATIENTS.

In children an insulin infusion may be used, starting at approximately 0.05 units of insulin per kilogram body weight per hour, usually made up as 50 units of fast acting insulin in 50 ml of normal saline. Note that it is mandatory under these circumstances to also have a glucose infusion running, and to keep a very close eye on the blood sugar level.