Emergent Hyperkalemia Treatment Algorithm
ECG changes, weakness, K+ >6.5 Or renal insufficiency with K >5.5 with cellular breakdown (ongoing rhabo, crush injury, etc)
ECG changes? (peaked T waves, prolonged PR, wide QRS, bradycardia, AV blocks)
-> Calcium - Stabilizes cardiac membrane
Shift K+ into cells - Combo of insulin + beta-agonist = greatest reduction
• Insulin
Onset <15 minutes, lasts -2 hours
Dose: 5 units regular insulin
Side effect: hypoglycemia in up to 20% of patients, monitor glucose x 3 hrs
Give 25 g dextrose if glucose 100-200 mg/dL or 50 g if glucose <100
• Beta-agonist
Onset 20-30 minutes, lasts ~2 hours
Dose: 10-20 mg nebulized
• Sodium Bicarbonate
Limited utility, not to be used as a standalone treatment
Remove potassium
• Hemodialysis
• Time and removal of offending agent (ACE-I. dehydration. obstruction. etc)
• Exchange resins - Sodium polystrene sulfonate (kayexelate) and others lower K+ in hours to days (not quickly)
#Hyperkalemia #Treatment #Algorithm #Management
