Hypoglycaemia due to HIET
Hypoglycaemia is a common adverse effect of giving high-dose insulin in HIET for inotropic support. Hypoglycaemia can occur during HIET, even when an intravenous glucose infusion is running. If hypoglycaemia occurs, treat with top-up intravenous bolus injections of glucose every 30 to 60 minutes to achieve a blood glucose concentration between 4 and 8 mmol/L.
Hypoglycaemia can persist for many hours after the insulin infusion has stopped, and recur after the glucose infusion has stopped. Monitor the blood glucose concentration for at least 24 hours after HIET.
If top-up intravenous bolus injections of glucose are required for adults, use:
1 glucose 50% 50 mL intravenously, by slow injection, preferably via a central venous catheter or a large peripheral vein, every 30 to 60 minutes to achieve a blood glucose concentration between 4 and 8 mmol/L
OR
1 glucose 10% 250 mL intravenously, by slow injection, via a large peripheral vein, every 30 to 60 minutes to achieve a blood glucose concentration between 4 and 8 mmol/L.
If top-up intravenous bolus injections of glucose are required for children, use:
glucose 10% 2.5 mL/kg intravenously, by slow injection, via a large peripheral vein, every 30 to 60 minutes to achieve a blood glucose concentration between 4 and 8 mmol/L.
If hypoglycaemia is refractory to glucose therapy, consult a clinical toxicologist.