A lot of MICUs in NJ used to carry insulin. The purpose was for presumed hyperkalemia-induced cardiac arrest in dialysis patients, though considering that it could only given if orders received from a doc, it is possible that some docs could order it for other situations. I think insulin is still part of NJ's optional meds, so there may still be some places carrying it.
Insulin
- Thread starter xrsm002
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How critical is insulin for severe hyperkalemia in the early stages of treatment? I understand it's used as part of the hyperkalemia cocktail, but I'd presume calcium chloride is more effective in the short term.
CaCl is more rapid in its onset of action, but is temporary. Ca is more of a stop-gap measure to give time for other treatments to take effect. When you don't have any labs available, it is probably a lot safer to bolus someone with CaCl and fluids than to use D50 and insulin. Without labs, using insulin is probably only acceptable in extreme case (cardiac arrest) or with ECG changes consistent with HyperK AND hemodynamic instability.