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Commentary

Insulin dosing error in a patient with severe hyperkalemia.

Hewitt B, Barnard C, Bilimoria KY. Insulin Dosing Error in a Patient With Severe Hyperkalemia. JAMA. 2017;318(24):2485-2486. doi:10.1001/jama.2017.7964.

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January 17, 2018
Hewitt B, Barnard C, Bilimoria KY. JAMA. 2017;318(24):2485-2486.
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This case report describes an insulin dosing error during hospitalization. The investigation uncovered several root causes, including lack of a standardized medication double-check. The authors note that prompt error disclosure to the patient and family was performed, and the patient required additional monitoring but experienced no further harm.

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Hewitt B, Barnard C, Bilimoria KY. Insulin Dosing Error in a Patient With Severe Hyperkalemia. JAMA. 2017;318(24):2485-2486. doi:10.1001/jama.2017.7964.