{"id":453,"date":"2019-12-23T15:55:58","date_gmt":"2019-12-23T14:55:58","guid":{"rendered":"https:\/\/admsu.org\/?p=453"},"modified":"2019-12-23T18:30:16","modified_gmt":"2019-12-23T17:30:16","slug":"staff-biblio-n2","status":"publish","type":"post","link":"https:\/\/admsu.org\/w\/staff-biblio-n2\/","title":{"rendered":"Staff biblio n\u00b02"},"content":{"rendered":"\n<h2 class=\"wp-block-heading\">Assessment of Intravenous Insulin Dosing Strategies  for the Treatment of Acute Hyperkalemia in the  Emergency Department<\/h2>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"alignright size-large is-resized\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/12\/Contre-lhypertension-5.2.png\" alt=\"\" class=\"wp-image-456\" width=\"197\" height=\"174\" srcset=\"https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/12\/Contre-lhypertension-5.2.png 750w, https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/12\/Contre-lhypertension-5.2-300x266.png 300w, https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/12\/Contre-lhypertension-5.2-560x497.png 560w\" sizes=\"auto, (max-width: 197px) 100vw, 197px\" \/><\/figure><\/div>\n\n\n\n<p>Katherine P. Keeney, PharmD; Chara  Calhoun, PharmD, BCPS; Lindsey Jennings, MD, MPH; Erin R. Weeda, PharmD, BCPS;  Kyle A. Weant, PharmD, BCPS, BCCCP , FCCP The American Journal of Emergency Medicine Available online 26 July 2019  <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/31377014\" target=\"_blank\" rel=\"noreferrer noopener\" aria-label=\"DOI: 10.1016\/j.ajem.2019.158374 (s\u2019ouvre dans un nouvel onglet)\">DOI: 10.1016\/j.ajem.2019.158374<\/a><\/p>\n\n\n\n<p><strong>Pr\u00e9sent\u00e9<\/strong> par Alicia Debois et la Dr Marie Delahaye<\/p>\n\n\n\n<p><strong>PICO<\/strong> : Quelle est chez le patient pr\u00e9sentant une hyperkali\u00e9mie trait\u00e9e par insuline glucose l&#8217;incidence de l&#8217;hypoglyc\u00e9mie iatrog\u00e8ne.<\/p>\n\n\n\n<p><strong>R\u00e9ponse des auteurs<\/strong> : une dose d&#8217;insuline de 5ui chez les patients ayant un DFG&lt;45 ml\/min\/1.73m2  g\u00e9n\u00e8re moins d&#8217;hypoglyc\u00e9mie et est aussi efficace pour traiter l&#8217;hyperkali\u00e9mie.<\/p>\n\n\n\n<p><strong>Pourquoi cette question<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Le gold standard du traitement de l&#8217;hyperkali\u00e9mie aig\u00fce recommande une dose de 10ui d&#8217;insuline<ul><li> recommandation du National Kidney Fondation<\/li><\/ul><\/li><li> potassium et insuline son d\u00e9pendant du rein pour leur m\u00e9tabolisme<ul><li> les \u00e9tudes pr\u00e9c\u00e9dentes sont en faveur d&#8217;une adaptation des doses d&#8217;insuline en fonction du DFG<\/li><\/ul><\/li><\/ul>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"alignright size-large is-resized\"><a href=\"https:\/\/admsu.org\/?attachment_id=454\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/12\/biblio2.png\" alt=\"\" class=\"wp-image-454\" width=\"223\" height=\"226\" srcset=\"https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/12\/biblio2.png 301w, https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/12\/biblio2-296x300.png 296w, https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/12\/biblio2-100x100.png 100w\" sizes=\"auto, (max-width: 223px) 100vw, 223px\" \/><\/a><\/figure><\/div>\n\n\n\n<p><strong>M\u00e9thode<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>R\u00e9trospective,  Monocentrique -&gt; H\u00f4pital universitaire de Californie, USA<\/li><li> Inclusion par revue des dossiers de patients ayant re\u00e7u une dose unique d\u2019insuline pendant leur passage aux urgences entre Janvier 2015 et Ao\u00fbt 2018.<\/li><li> Patient assign\u00e9 au groupe en fonction de la dose d\u2019insuline re\u00e7ue : 10 UI (High dose) vs 5 UI (Low dose)<\/li><li> Valeurs de glyc\u00e9mie et kali\u00e9mie retenue : 1er dosage r\u00e9alis\u00e9 dans les 6H post injection<\/li><li> D\u00e9finition de l\u2019hypoglyc\u00e9mie : &lt;70 mg\/l Stratification des patients en fonction du DFG selon Cockroft ( 45ml\/min\/1,73m2)<\/li><\/ul>\n\n\n\n<p><strong>R\u00e9sultats<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Comparabilit\u00e9 des groupes :<ul><li> Utilisation de gluconate de calcium (p=0,03) et de Kayexalate (p&lt;0,001) plus fr\u00e9quente dans le groupe High dose.<\/li><li>Pas de diff\u00e9rences significatives entre les groupes pour les autres crit\u00e8res <\/li><\/ul><\/li><li>Analyse avant stratification :<ul><li>Hypoglyc\u00e9mie plus fr\u00e9quente dans le groupe High dose (15,6% vs 6,1% ; p=0,004) <\/li><li>Pas de diff\u00e9rence d&#8217;efficacit\u00e9 sur la baisse de la kali\u00e9mie (p=0,63) <\/li><\/ul><\/li><li>Analyse apr\u00e8s stratification en fonction du DFG : <ul><li>DFG &gt; 45 ml\/min\/1,73m2 :<ul><li> Pas de diff\u00e9rence significative<\/li><\/ul><\/li><\/ul><ul><li> DFG &lt; 45 ml\/min\/1,73m2 :<ul><li> Plus d\u2019hypoglyc\u00e9mie dans le groupe High dose (17,4% vs 7,9%, p=0,02)<\/li><li> Pas de diff\u00e9rence d\u2019efficacit\u00e9 sur la baisse de la kali\u00e9mie (p=0,63)<\/li><\/ul><\/li><\/ul><\/li><\/ul>\n\n\n\n<p><strong>Limite<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>r\u00e9trospective en ouvert monocentrique<\/li><li>nombreux patients exclus<\/li><li>donn\u00e9es manquantes dans les dossiers<\/li><li>\u00e9tude de grade de recommandations C niveau de preuve 4 selon la HAS<\/li><\/ul>\n\n\n\n<p><strong>Discussion<\/strong><\/p>\n\n\n\n<p>3 \u00e9tudes r\u00e9alis\u00e9s en 2015, 2017 et 2018 ont montr\u00e9 :<br> \u274f Efficacit\u00e9 similaire des doses de 10 UI et 5 UI d\u2019insuline<br> \u274f Diminution significative des hypoglyc\u00e9mies iatrog\u00e8nes avec une dose d\u2019insuline moindre.<br> \u274f Mais pas de stratification de la population en fonction de la fonction r\u00e9nale<\/p>\n\n\n\n<p><strong>Commentaire du groupe de lecture<\/strong><\/p>\n\n\n\n<p>Privil\u00e9gier le protocole Glucos\u00e9 5% Perf discontinue 500 ml + Umuline rapide INJ 5 unit\u00e9s sur  30min <\/p>\n","protected":false},"excerpt":{"rendered":"<p>Assessment of Intravenous Insulin Dosing Strategies for the Treatment of Acute Hyperkalemia in the Emergency Department Katherine P. Keeney, PharmD; Chara Calhoun, PharmD, BCPS; Lindsey Jennings, MD, MPH; Erin R. Weeda, PharmD, BCPS; Kyle A. Weant, PharmD, BCPS, BCCCP , FCCP The American Journal of Emergency Medicine Available online 26 July 2019 DOI: 10.1016\/j.ajem.2019.158374 Pr\u00e9sent\u00e9 &hellip; <\/p>\n<p class=\"link-more\"><a href=\"https:\/\/admsu.org\/w\/staff-biblio-n2\/\" class=\"more-link\">Continuer la lecture<span class=\"screen-reader-text\"> de &laquo;&nbsp;Staff biblio n\u00b02&nbsp;&raquo;<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[73],"tags":[83,84],"class_list":["post-453","post","type-post","status-publish","format-standard","hentry","category-biblio-commentee","tag-hyperkaliemie","tag-insuffisance-renale"],"_links":{"self":[{"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/posts\/453","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/comments?post=453"}],"version-history":[{"count":3,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/posts\/453\/revisions"}],"predecessor-version":[{"id":465,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/posts\/453\/revisions\/465"}],"wp:attachment":[{"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/media?parent=453"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/categories?post=453"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/tags?post=453"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}