Insulin Therapy in Divided Doses Coupled With Blood Transfusion Versus Large Bolus Doses in Patients at High Risk for Hyperkalemia During Liver Transplantation

• Published in: Journal of cardiothoracic and vascular anesthesia Vol. 24; no. 1; pp. 80 - 83
• Main Authors: Xia, Victor W., MD, Obaidi, Rafee, BS, Park, Chulsoo, MD, Braunfeld, Michelle, MD, Neelakanta, Gundappa, MD, Nourmand, Hamid, MD, Hu, Ke-Qin, MD, Steadman, Randolph H., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-02-2010
• Subjects: Anesthesia & Perioperative Care; Blood Glucose; blood transfusion; Combined Modality Therapy; Critical Care; Drug Administration Schedule; Erythrocyte Transfusion; Female; Humans; Hyperglycemia - etiology; Hyperglycemia - prevention & control; hyperkalemia; Hyperkalemia - etiology; Hyperkalemia - prevention & control; Hypoglycemic Agents - administration & dosage; insulin; Insulin - administration & dosage; Insulin - physiology; liver transplantation; Liver Transplantation - adverse effects; Male; Middle Aged; Potassium - blood; Reperfusion Injury; Retrospective Studies; Risk Factors; Treatment Outcome; blood transfusion; risk factors; insulin; liver transplantation; hyperkalemia
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2009.01.032

Objective To assess the effectiveness of an insulin regimen in divided doses designed to target risk factors of hyperkalemia in patients undergoing liver transplantation. Design Retrospective comparison of the divided insulin dose regimen with a conventional large-bolus insulin method during liver transplantation. Setting University-based, academic, tertiary center. Participants Adult patients whose baseline potassium levels were ≥4.0 mmol/L and received insulin therapy during liver transplantation at the authors' medical center between January 2004 and April 2007. Interventions Insulin was administered either in divided doses (1-2 units) for each unit of red blood cells transfused or in a large-bolus in patients at high risk for hyperkalemia during liver transplantation. Measurements and Main Results Among 717 patients who underwent liver transplantation, 50 patients received insulin in divided doses, and 101 patients received a large-bolus of insulin. Perioperative characteristics were comparable except for higher insulin doses in the large-bolus group. The divided insulin regimen was associated with significantly lower mean potassium levels within 2 hours before reperfusion of the graft compared with the conventional group ( p < 0.005). The mean glucose levels in the divided group were significantly lower in both the pre- and postreperfusion periods than in the conventional group ( p < 0.05 to <0.001). Conclusions The divided insulin dose regimen that specifically targets the risk factors for prereperfusion hyperkalemia is associated with significantly lower prereperfusion potassium and pre- and postreperfusion glucose levels and provides a useful alternative to the conventional large-bolus method in management of intraoperative hyperkalemia during liver transplantation.