Predicting hypoglycemia after treatment of hyperkalemia with insulin and glucose (Glu-K60 score)
Dublin Core
Title
Predicting hypoglycemia after treatment of hyperkalemia with insulin and glucose (Glu-K60 score)
Subject
Hyperkalemia, Hypoglycemia, Insulin, Prediction
Description
Background: Hyperkalemia can lead to fatal cardiac arrhythmias. Ten units of intravenous (IV) regular insulin
with 25 g of glucose is the mainstay for treating hyperkalemia. However, the most important complication of this
treatment is hypoglycemia. We aimed to develop a scoring model to predict hypoglycemia after the treatment of
hyperkalemia.
Methods: A retrospective study was conducted at a university-based hospital between January 2013 and June 2021.
We included the hyperkalemic patients (>5.3 mmol/L) who were≥18 years old and treated with 10 units of IV regular
insulin with 25 g of glucose. Incomplete data on posttreatment blood glucose, pregnancy, and diabetes mellitus were
excluded. Endpoint was posttreatment hypoglycemia (≤70 mg/dL or≤3.9 mmol/L). Multivariable logistic regression was used to establish a full model and a subsequently reduced model using the backward elimination method.
We demonstrated the model performance using the area under the receiver operating characteristic curve (AuROC),
calibration plot, and Hosmer–Lemeshow goodness-of-ft test. Internal validation was done with a bootstrap sampling
procedure with 1000 replicates. Model optimism was estimated.
Results: Three hundred and eighty-fve patients were included, with 97 posttreatment hypoglycemia (25.2%). The
predictive model comprised the following three criteria: age>60 years old, pretreatment blood glucose≤100 mg/
dL (≤5.6 mmol/L), and pretreatment potassium>6 mmol/L. The AuROC of this model was 0.671 (95% confdence
interval [CI] 0.608 to 0.735). The calibration plot demonstrated consistency with the original data. Hosmer–Lemeshow
goodness-of-ft test showed no evidence of lack-of-ft (p 0.792); therefore, the model was also ft to the original data.
Internal validation via bootstrap sampling showed a consistent AuROC of 0.670 (95% CI 0.660 to 0.670) with minimal
model optimism. A high risk for posttreatment hypoglycemia was indicated if the patient met at least one of those
criteria. Sensitivity and specifcity were 95.9% and 14.9%, respectively.
Conclusion: High risk was indicated when at least one of the criteria was met: age>60 years old, pretreatment
blood glucose≤100 mg/dL (≤5.6 mmol/L), and pretreatment potassium>6 mmol/L. Blood glucose levels should
frequently check in the high-risk group.
Trial registration: TCTR20210225002 (www.thaiclinicaltrials.org).
with 25 g of glucose is the mainstay for treating hyperkalemia. However, the most important complication of this
treatment is hypoglycemia. We aimed to develop a scoring model to predict hypoglycemia after the treatment of
hyperkalemia.
Methods: A retrospective study was conducted at a university-based hospital between January 2013 and June 2021.
We included the hyperkalemic patients (>5.3 mmol/L) who were≥18 years old and treated with 10 units of IV regular
insulin with 25 g of glucose. Incomplete data on posttreatment blood glucose, pregnancy, and diabetes mellitus were
excluded. Endpoint was posttreatment hypoglycemia (≤70 mg/dL or≤3.9 mmol/L). Multivariable logistic regression was used to establish a full model and a subsequently reduced model using the backward elimination method.
We demonstrated the model performance using the area under the receiver operating characteristic curve (AuROC),
calibration plot, and Hosmer–Lemeshow goodness-of-ft test. Internal validation was done with a bootstrap sampling
procedure with 1000 replicates. Model optimism was estimated.
Results: Three hundred and eighty-fve patients were included, with 97 posttreatment hypoglycemia (25.2%). The
predictive model comprised the following three criteria: age>60 years old, pretreatment blood glucose≤100 mg/
dL (≤5.6 mmol/L), and pretreatment potassium>6 mmol/L. The AuROC of this model was 0.671 (95% confdence
interval [CI] 0.608 to 0.735). The calibration plot demonstrated consistency with the original data. Hosmer–Lemeshow
goodness-of-ft test showed no evidence of lack-of-ft (p 0.792); therefore, the model was also ft to the original data.
Internal validation via bootstrap sampling showed a consistent AuROC of 0.670 (95% CI 0.660 to 0.670) with minimal
model optimism. A high risk for posttreatment hypoglycemia was indicated if the patient met at least one of those
criteria. Sensitivity and specifcity were 95.9% and 14.9%, respectively.
Conclusion: High risk was indicated when at least one of the criteria was met: age>60 years old, pretreatment
blood glucose≤100 mg/dL (≤5.6 mmol/L), and pretreatment potassium>6 mmol/L. Blood glucose levels should
frequently check in the high-risk group.
Trial registration: TCTR20210225002 (www.thaiclinicaltrials.org).
Creator
Weerapriya Kijprasert, Nilanut Tarudeeyathaworn, Chananthita Loketkrawee, Thidarat Pimpaporn, Pornpiyapat Pattarasettaseranee and Theerapon Tangsuwanaruk
Publisher
BMC Emergency Medicine
Date
(2022) 22:179
Contributor
Fajar Bagus W
Format
PDF
Language
English
Type
Text
Files
Collection
Citation
Weerapriya Kijprasert, Nilanut Tarudeeyathaworn, Chananthita Loketkrawee, Thidarat Pimpaporn, Pornpiyapat Pattarasettaseranee and Theerapon Tangsuwanaruk, “Predicting hypoglycemia after treatment of hyperkalemia with insulin and glucose (Glu-K60 score),” Repository Horizon University Indonesia, accessed September 20, 2024, https://repository.horizon.ac.id/items/show/4285.