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

ObjectiveTo assess the effectiveness of an insulin regimen in divided doses designed to target risk factors of hyperkalemia in patients undergoing liver transplantation.DesignRetrospective comparison of the divided insulin dose regimen with a conventional large-bolus insulin method during liver transplantation.SettingUniversity-based, academic, tertiary center.ParticipantsAdult 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.InterventionsInsulin 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 ResultsAmong 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).ConclusionsThe 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.