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Acute Hyperkalemia - #MEDSHED

🍌Acute hyperkalemia is a common electrolyte abnormality that can potentially be life-threatening, if not recognized and treated appropriately.

 



🍌Acute hyperkalemia is a common electrolyte abnormality that can potentially be life-threatening, if not recognized and treated appropriately.


💉 Treatment consists of stabilizing the myocardium, transiently shifting potassium into the cell, and elimination of potassium.


🐄 Stabilize myocardium with calcium salts.

Calcium chloride 1 gm IV over 2 - 3 mins

Calcium gluconate 3 gm IV over 2 - 3 mins.

Duration 30 - 60 minutes, consider redosing.

Not benign; can contribute to calciphylaxis in chroinic kidney disease patients.


🍬 Insulin/Dextrose Severe hyperkalemia: Insulin regular 10 units IV

Risk of hypoglycemia, Low BMI/initial BG, Insulin naive, Renal insufficiency, ElderlyReduce insulin dose and/or increase dextrose: 0.1 units/kg (up to 10 units) or 5 units IV+ 1 amp D50W: 25 gm; 1 D10W 250mL bag: 25 gm. Consider 50gm total when BG around 100 mg/dL


💩 Potassium binders have limited utility in the the acute setting. The final solution often for critical hyperkalemia is emergent hemodialysis.


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