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Hyperkalemia Treatment
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Emergency treatment of hyperkalemia is targeted towards one of three objectives:

bullet Antagonizing calcium, eg Calcium Chloride administration
bullet Causing potassium to shift into cells, eg with administration of sodium bicarbonate, insulin + glucose, or nebulized albuterol
bullet Removing potassium from the body, eg with diuresis with a non-potassium-sparing diuretic, administration of cation exchange resin, or dialysis

 

Therapy

Dose

Onset of Effect

Duration of Effect

Calcium chloride 5-10 ml IV of 10% solution (500-1000mg 1-3 minutes 30-60 minutes
Sodium bicarbonate 1 mEq/kg IV bolus 5-10 minutes 1-2 hours
Insulin plus glucose (use 1 unit of insulin/2.5 g glucose) Regular insulin 10 U IV plus 50 ml D50 (25 g glucose) IV bolus 30 minutes 4-6 hours
Nebulized albuterol 10-20 mg nebulized over 15 minutes 15 minutes 15-90 minutes
Furosemide 40-80 mg IV bolus With onset of diuresis Until diuretic effect ends
Kayexalate 15-50 g PO or PR, plus sorbitol 1-2 hours 4-6 hours
Peritoneal dialysis or hemodialysis Per institution Immediate Until dialysis completed

 

* - Information taken from Handbook of Hazinski, M et al, eds. Emergency Cardiovascular Care for Healthcare Providers 2002, produced by the American Heart Association.