Journal article
Comparison of Single-Dose Intravenous Insulin Regular vs. Insulin Lispro for Hyperkalemia Treatment in the Emergency Department: The SIR-LISPRO Trial
The American journal of emergency medicine, Vol.101, pp.92-98
03/2026
DOI: 10.1016/j.ajem.2025.12.031
PMCID: PMC12810486
PMID: 41477935
Abstract
Hyperkalemia is a potentially life-threatening electrolyte disturbance that is present in 2 % to 3 % of emergency department (ED) patient admissions. These patients are commonly treated with intravenous (IV) insulin. Standard of care consists of administering IV insulin regular, but other insulin formulations might be safer and/or more effective, however this has yet to be explored.
To evaluate the safety and effectiveness of insulin lispro and insulin regular administered intravenously for the treatment of hyperkalemia in ED patients.
This was a retrospective cohort study that investigated adults that were admitted to the ED of two academic centers and treated for hyperkalemia with 5 units of IV insulin therapy from January 1, 2022, through January 1, 2023. The primary outcome was the change in serum potassium within 6 h following IV insulin regular compared to IV insulin lispro. The primary safety outcome was the proportion of patients who had a hypoglycemic event (blood glucose <70 mg/dl) or required supplemental dextrose administration within 6 h post-insulin administration. Demographic, clinical characteristics, clinical management, and the outcome of change in potassium were associated using linear regression. Dichotomous outcomes pertaining to hypoglycemia were estimated using logistic regression.
Among the 237 patients who met inclusion criteria, 129 received insulin regular, and 108 patients received insulin lispro. We observed a larger decrease in potassium in those that received insulin lispro compared to those that received insulin regular (uMD: -0.24; 95 %CI: −0.42, −0.06). The odds of hypoglycemia were greater among those who received insulin lispro (16 %) compared to insulin regular (7 %) (uOR: 2.49; 95 %CI: 1.08, 6.09).
Intravenous insulin lispro resulted in a statistically significant reduction of serum potassium but resulted in a higher likelihood of hypoglycemia compared to IV insulin regular. Further prospective, controlled studies are needed to assess the clinical significance of the differences between insulin formulations.
Details
- Title: Subtitle
- Comparison of Single-Dose Intravenous Insulin Regular vs. Insulin Lispro for Hyperkalemia Treatment in the Emergency Department: The SIR-LISPRO Trial
- Creators
- Christian Kroll - University of IowaMahnoor Khan - University of Wisconsin HealthJiayi Sun - Department of Emergency Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USAPriyanka Vakkalanka - University of IowaKasheng Lee - University of Wisconsin HealthMarianne Said - University of IowaJoseph Halfpap - University of Wisconsin Health
- Resource Type
- Journal article
- Publication Details
- The American journal of emergency medicine, Vol.101, pp.92-98
- DOI
- 10.1016/j.ajem.2025.12.031
- PMID
- 41477935
- PMCID
- PMC12810486
- NLM abbreviation
- Am J Emerg Med
- ISSN
- 0735-6757
- eISSN
- 1532-8171
- Publisher
- Elsevier Inc
- Number of pages
- 7
- Grant note
- National Center For Advancing Translational Sciences of the National Institutes of Health: UM1TR004403
Research reported in this publication was supported by the National Center For Advancing Translational Sciences of the National Institutes of Health under Award Number UM1TR004403. The content is solely the responsibility of the authors and does not necessarily represent the of-ficial views of the National Institutes of Health. The authors also ac-knowledge Dr. Brett Faine, PharmD, MS in reviewing the manuscript.
- Language
- English
- Date published
- 03/2026
- Academic Unit
- Epidemiology; Emergency Medicine; Pharmacy Practice and Science; Injury Prevention Research Center
- Record Identifier
- 9985121593302771
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