Treating hyperkalemia : avoid additional harm when using insulin and dextrose Pennsylvania patient safety advisory Lawes, Staley, author. Gaunt, Michael J., author. Grissinger, Matthew, author. Hyperkalemia -- drug therapy Hypoglycemia -- chemically induced Hypoglycemia -- prevention & control Medication Errors -- prevention & control Hyperkalemia is a fairly common, potentially life-threatening electrolyte disturbance encountered in hospitalized patients. Treatment of hyperkalemia with insulin and dextrose, without implementing clear protocols and error reduction strategies, can lead to hypoglycemia and other patient harm. A total of 198 events involving insulin and dextrose for treating hyperkalemia were identified by analysts in reports submitted to the Pennsylvania Patient Safety Authority between January 1, 2005, and December 31, 2016. The three most commonly reported types of events were delayed dose (n = 42), wrong route (n = 41), and wrong dose/over dosage (n = 15). Hypoglycemic episodes were reported in 57 of 198 patients. Standardized treatment protocols, including proper monitoring, can help prevent and detect errors with insulin administration for this indication. [Harrisburg, Pa.] : Pennsylvania Patient Safety Authority, September 2017 Pennsylvania. Patient Safety Authority, issuing body. ECRI (Organization), issuing body. Institute for Safe Medication Practices, issuing body. Technical Report Text Illustrations 1 online resource (1 PDF file (11 pages)) nlm:nlmuid-101715808-pdf 101715808 http://resource.nlm.nih.gov/101715808 English Pennsylvania United States Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY-NC-DC license. https://creativecommons.org/licenses/by-nc-nd/3.0