Glucose insulin potassium infusion

S.R. Mehta, S. Yusuf, R. Diaz, J. Zhu, P. Pais, D. Xavier, E. Paolasso, R. Ahmed, C. Xie, K. Kazmi, J. Tai, A. Orlandini, J. Pogue, L. Liu CREATE-ECLA Trial Group Investigators, Effect of glucose-insulin-potassium infusion on mortality in patients with acute ST-segment elevation myocardial infarction the CREATE-ECLA randomized controlled trial, JAMA. 293(4), 437-446 (2005). 

Glucose insulin potassium (GIK) infusion has been suggested by some to offer additional myocardial salvage in the setting of an acute Ml. Theoretically, GIK infusion provides glycolytic fuel to both the starving ischemic myocardium before intervention and the reperfused myocardium after PCI. It is also thought to decrease free fatty acid (FFA) levels and toxic FFA uptake by the ischemic myocardium. 

Scott JF, Robinson GM, French JM, O Connell JE, Alberti KG, Gray CS. Glucose potassium insulin infusions in the treatment of acute stroke patients with mild to moderate hyperglycemia the glucose insulin in stroke trial (GIST). Stroke 1999 30 793-799. 

Glucose-potassium-insulin infusions in the management of post-stroke hyperglycaemia the UK Glucose Insulin in Stroke Trial (GIST-UK). Lancet Neurolo 6 397-406... 

Current concepts of resuscitation after local anesthetic cardiotoxicity have been reviewed (17). Vasopressin may be a logical vasopressor in the setting of hypotension, rather than adrenaline, in view of the dysrhythmogenic potential of the latter. Amiodarone is probably of use in the treatment of dysrhythmias. Calcium channel blockers, phenytoin, and bretyllium should be avoided. In terms of new modes of therapy targeted at the specific action of local anesthetics, lipid infusions, propofol, and insulin/ glucose/potassium infusions may all have a role, but further research is necessary. 

D. Sodi-Pallares, M.R. Testelli, B.L. Fishleder, A. Bisteni, G.A. Medrano, C. Friedland, and A. De Micheli, Effects of an intravenous infusion of a potassium-glucose-insulin solution on the electrocardiographic signs of myocardial infarction. A preliminary clinical report, Am J Cardiol 9, 166-181(1962). 

In hyperkalemia, infusion of glucose and insulin produces a shift of potassium into cells and lowers serum potassium levels. 

Parenteral /32-agonists such as albuterol (salbuta-mol) increase the activity of the membrane sodium-potassium ATPase, and so increase potassium entry into cells. Nebulized or infused albuterol (salbutamol) significantly lowers serum potassium concentration over 5 hours. A suitable initial dose of nebulized albuterol is 5 mg in adults. It can provoke tremor and tachyarrhythmia, and it is desirable to monitor cardiac rhythm during nebulization. The combination of nebulized albuterol (salbutamol) with infusion of insulin + glucose is more effective than the infusion alone. 

The commonest form of treatment for acute hyperkalaemia is the infusion of insulin and glucose to move potassium ions into cells. An infusion of calcium gluconate may also be given to counter-aci the effects of hyperkalaemia. Dialysis is fretiticntly necessary to treat severe hyperkalaemia. When there is a slow rise in the plasma potassium this may be stopped or reversed by oral administration of a cation exchange resin such as Resonium A. 

The treatment of hyperkalemia is to infuse slowly intravenous calcium gluconate (10 mL of 10% solution over 3 min). Soluble insulin (15 U intravenously) and 50 mL of 50% glucose solution should also be given intravenously [26], Plasma potassium should be determined hourly. Intravenous salbutamol also causes a reduction of serum potassium possibly by activating P-adrenergically stimulated membrane Na, K -ATPase [27). Longer term treatment might involve hemodialysis. 

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