Insulin for the treatment of hyperkalemia: a double-edged sword?

Abstract

Potassium plays a critical role in cellular metabolism and normal neuromuscular function. Tightly regulated homeostatic mechanisms have developed in the process of evolution to provide primary defense against the threats of hyper- and hypokalemia. The kidney plays a primary role in potassium balance, by increasing or decreasing the rate of potassium excretion. Distribution of potassium between the intracellular and the extracellular fluid compartments is regulated by physiologic factors such as insulin and catecholamines which stimulate the activity of the Na⁺-K⁺ ATPase. Only about 10% of the ingested potassium is excreted via the gut under normal physiologic conditions [1].