Effect of insulin on hyperkalemia during anhepatic stage of liver transplantation

AIM:To investigate the effectiveness of insulin on decreasingserum potassium concentration during anhepatic stage oforthotopic liver transplantation.METHODS:Sixteen patients with serum potassiumconcentrations greater than 4.0 mmol/L at the onset ofanhepatic stage were randomized into two groups.Thepatients in control group (n=8) received no treatment,while those in treatment group (n=8) received anintravenous bolus injection of regular insulin (20U) 10 mininto the anhepatic stage,followed by a glucose infusion(500mL 50g/L dextrose) over 15 min.RESULTS:In control group,potassium concentrationunderwent no changes whereas in treatment group,itdecreased from 4.8±0.48 mmol/L to 4.19±0.55 mmol/L(mean±SD) within 15 min and to 3.62±0.45 mmol/L60 min after the therapy.The potassium concentrationwas lower in treatment group than in control group within30 min of treatment (3.94±0.57 vs 4.47±0.42 mmol/L,respectively;P<0.05),and increased similarly 30 s aftergraft reperfusion in both groups of patients,but remainedlower in treatment group (5.81±2.78 vs 7.44±1.75 mmol/L,respectively;P<0.05).The potassium concentrationreturned to pre-reperfusion levels within 5 min after graftreperfusion.CONCLUSION:In patients undergoing orthotopic livertransplantation,the administration of insulin rapidlydecreases serum potassium concentration even in theabsence of the liver,suggesting an important contributionby extrahepatic tissues in insulin-stimulated uptake ofpotassium.