Treatment of hyperkalemia with high dose intravenous insulin during extracorporeal circulation
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Background: Glucose-insulin infusion can be used in the treatment of hyperkalemia seen in extracorporeal circulation (ECC) during cardiac surgery. We aimed to investigate the relationship between the dose of the insulin and the rate of decrease in blood potassium level. Design: The study is designed to compare two different doses of insulin in hyperkalemic patients during ECC. Methods: Thirty six hyperkalemic patients, to whom continuous retrograde warm blood cardioplegia was applied, were allocated to the study. Patients having blood potassium level of 7 mmol/L and above were allocated to the group I and of 6-7 mmol/L to group II. Fifty units of insulin was given intravenously to the group I patients and 25 units to the group II patients. Blood potassium and glucose level were monitored. The time to get the blood potassium level of 5.5 mmol/L, and complications were compared. Results: The time to get blood potassium level of 5.5 mmol/L was 22.7 ± 1.9 min in group I, and 15.7 ± 0.8 min in group II (p<0.05). The decrease in potassium level was 1.78 mmollL and the rate of decrease in blood potassium level was 0.078 mmol/L lmin in group I, and 0.076 mmol/L and 0.048 mmollLlmin in group II, respectively (p<0.05). Complication rate was higher in group I (p< 0.05). Conclusions: This study is the first study about the doses of insulin in patients with hyperkalemia during ECC. Insulin in the doses of 25-50 units can be used safely in the treatment of hyperkalemia during ECC.