Low rates of hyponatraemia in patients with diabetes treated with variable rate intravenous insulin infusion (VRIII)

Zeenat Banu, Daniel Flanagan

Abstract


Aims: To investigate the risk of developing hyponatraemia or hypoglycaemia in individuals requiring variable rate intravenous insulin infusion (VRIII) using a protocol of variable rate insulin infused with 10% dextrose and 20 mmol/L potassium chloride.

Methods: A prospective study was performed of 50 consecutive medical and surgical patients requiring VRIII. Sodium, potassium and glucose were measured before, during and after VRIII use.

Results: Medical patients had significantly higher glucose values prior to VRIII. Glucose fell significantly in this group. Sodium concentrations were marginally low prior to commencing VRIII in seven medical and six surgical patients. One patient had significant hyponatraemia prior to VRIII (114 mmol/L) and this improved to 118 mmol/L during the VRIII. Overall there were no significant changes in sodium or potassium during VRIII. There were no significant differences in sodium or potassium between the two groups at any point.

Conclusion: There was a low incidence of clinically significant hyponatraemia and hypokalaemia associated with a commonly used intravenous insulin regimen that combines insulin with 10% dextrose.


Keywords


variable rate intravenous insulin infusion, hypoglycaemia, hyponatraemia, hypokalaemia

Full Text:

PDF HTML

References


The use of variable rate intravenous insulin infusion (VRIII) in medical inpatients. The Joint British Diabetes Societies for Inpatient Care.https://www.diabetes.org.uk/Documents/About%20Us/What%20we%20say/Use%20of%20variable%20rate%20intravenous%20insulin%20infusion%20in%20medical%20inpatients.pdf

Peri-operative management of the surgical patient with diabetes 2015. The Association of Anaesthetists of Great Britain & Ireland https://www.aagbi.org/sites/default/files/Diabetes%20FINAL%20published%20in%20Anaesthesia%20Sept%2015%20with%20covers%20for%20online[1].pdf

Management of adults with diabetes undergoing surgery and elective procedures: Improving standards. The Joint British Diabetes Societies for Inpatient Care.

https://www.diabetes.org.uk/Documents/Professionals/Reports%20and%20statistics/Surgical%20guidelines%202015%20%20full%20FINAL%20amended%20Mar%202016.pdf

National Institute for Health and Care Excellence (2013) Intravenous fluids for adults in hospital. NICE guideline (CG174). London, UK.

Moghissi ES ,Korytkowski MT, DiNardo M et al. American Association of clinical endocrinologists; American diabetes Association, American association of clinical endocrinologists and American diabetes association consensus statement on inpatient glycemic control.Diabetes care 1009;32:1119-113.

Harris B, Schopflin C, Khaghani C, Edwards M; collaborators from the Southcoast Perioperative Audit and Research Collaboration (SPARC). . Perioperative intravenous fluid prescribing: a multi-centre audit.Perioper Med (Lond). 2015 Dec 18;4:15

Hoorn EJ, Lindemans J, Zietse R. Development of severe hyponatraemia in hospitalised patients: treatment related risk factors and inadequate management.Nephrol Dial Transplant 2006;21;70-6 https://doi.org/10.1093/ndt/gfi082

NaDIA. National Diabetes In patient Audit 2015. http://content.digital.nhs.uk/catalogue/PUB20206/nati-diab-inp-audi-15-nat-rep.pdf

J Chizo Agwa, JA Edge, J H Drew, et al. Association of Children’s Diabetes Clinicians. : Guidelines on the care of children under 18yrs of age with diabetes mellitus undergoing surgery. - Version 1, Oct 2013.

Smiley D, Rhee M,,Peng L, et al.Safety and efficacy of continuous insulin infusion in noncritical care settings.J Hosp Med 2010;5:212-217.




DOI: https://doi.org/10.15277/bjd.2019.206

Refbacks

  • There are currently no refbacks.


The Journal of the Association of British Clinical Diabetologists