Abstract
Background
Insulin–glucose therapy in hyperkalaemia treatment has a narrow therapeutic index for a safe and efficient use. We assess the variability of the effective delivered insulin under conditions used in the setting of hyperkalaemia treatment.
Methods
A range of simulated insulin infusions was studied using different containers (bag or syringes) according to the different hyperkalaemia treatment procedures of our institution. Insulin concentration was assayed using a chromatographic method on an automatic high-performance liquid chromatography. We calculated the effective delivered insulin and compared the time average of percentage delivered insulin (TAdi) between all the procedures.
Results
The TAdi was significantly decreased to 63.3% of the expected insulin delivery in the polyurethane (PE) bag compared with allover container. The procedure duration and the insulin concentration influenced the variability of the insulin delivery in the PE and glass bag. The polyvinyl chloride bag had the highest TAdi at 93.8%, without significant variation during the time. TAdi reaches ∼90% of the expected insulin with all the syringe procedure without variation according to the solute used to dilute insulin.
Conclusions
Clinically significant variations in intravenous insulin delivery occur in the setting of hyperkalaemia treatment according to the container. The use of propylene syringe limits the insulin delivery variation. In the future, clinical studies on hyperkalaemia treatment by insulin–glucose therapy should detail the procedure precisely.
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Details
1 Centre of Nephrology and Renal Transplantation, Hôpital de la Conception, CHU de Marseille, Marseille, France; MMG, Bioinformatics & Genetics, UMRS_1251, Aix-Marseille Université, Marseille, France
2 Service central de la qualité et de l'information pharmaceutiques (SCQIP), Pharmacy Department, Assistance Publique—Hôpitaux de Marseille (AP-HM), Marseille, France; Aix Marseille Univ, CNRS, Institut de Chimie Radicalaire ICR, UMR 7273, Equipe de Pharmaco-Chimie Radicalaire, Marseille, France
3 Centre of Nephrology and Renal Transplantation, Hôpital de la Conception, CHU de Marseille, Marseille, France; Aix-Marseille Univ, INSERM, INRAe, C2VN, Marseille, France
4 Hospital Pharmacy, Hôpital de la Conception, Pharmacy Department, Assistance Publique—Hôpitaux de Marseille (AP-HM), Marseille, France