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      Combined Effect of Bicarbonate and Insulin with Glucose in Acute Therapy of Hyperkalemia in End-Stage Renal Disease Patients

      Nephron

      S. Karger AG

      Bicarbonate, Insulin, Metabolic acidosis, Hyperkalemia, Hemodialysis

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          Abstract

          This study was performed to evaluate the efficacy of various treatment modalities for hyperkalemia in 8 end-stage renal disease (ESRD) patients. Simultaneous administration of sodium bicarbonate and insulin with glucose was compared with infusion of either bicarbonate alone or insulin and glucose. Plasma potassium was measured at the baseline and after 60 min of infusion with each regimen. Infusion of 8.4% solution of sodium bicarbonate at 2 mEq/ min for 60 min induced a significant rise in blood bicarbonate from 21.7 ± 2.1 to 26.3 ± 1.7 mEq/l (p < 0.01), but failed to lower plasma potassium (6.4 ± 0.1 vs. 6.3 ± 0.2 mEq/l, before and after). Intravenous infusion of insulin and glucose (5 mU/kg/min for 60 min) significantly lowered plasma potassium from 6.3 ± 0.1 to 5.7 ± 0.1 mEq/l (p < 0.01). The combined infusion of bicarbonate and insulin with glucose showed the greatest decline in plasma potassium, from 6.2 ± 0.2 to 5.2 ± 0.1 mEq/l (p < 0.01). With the combined regimen, the increases in plasma bicarbonate (22.3 ± 1.7 to 25.8 ± 1.9 mEq/l, p < 0.05) and blood pH (7.36 ± 0.02 to7.42 ± 0.02, p < 0.01) were significant, but somewhat less than those with bicarbonate administration alone. Plasma insulin levels before treatment were similar in all treatment regimens, and increased markedly following the infusion of insulin with glucose, either with or without sodium bicarbonate (9 ± 1.5 vs. 10 ± 10 μU/ml before insulin, and 196 ± 18.0 vs. 201 ± 26.4 μU/ml after insulin). Plasma epinephrine, norepinephrine, osmolality and plasma aldosterone before and after treatment did not show any significant differences among the 3 different regimens. In conclusion, the ineffectiveness of sodium bicarbonate alone and its synergistic effect with insulin and glucose in acute therapy of hyperkalemia in ESRD patients suggest that mild metabolic acidosis, which is common in patients on maintenance hemodialysis, may contribute to tissue insensitivity to the action of insulin on transcellular potassium shift.

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          Author and article information

          Journal
          NEF
          Nephron
          10.1159/issn.1660-8151
          Nephron
          S. Karger AG
          1660-8151
          2235-3186
          1996
          1996
          18 December 2008
          : 72
          : 3
          : 476-482
          Affiliations
          Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
          Article
          188917 Nephron 1996;72:476–482
          10.1159/000188917
          8852501
          © 1996 S. Karger AG, Basel

          Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

          Page count
          Pages: 7
          Categories
          Rapid Communication

          Cardiovascular Medicine, Nephrology

          Hemodialysis, Hyperkalemia, Metabolic acidosis, Insulin, Bicarbonate

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