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)



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