Hyperkalemia Management Summary
Management: acute ...
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Hyperkalemia Management Summary

Management: acute changes are most dangerous → STAT ECG: peaked T waves → flat P → ↑ PR interval ± AVB → wide QRS ± BBB → sine wave pattern → PEA / asystole / VF; ECG does not correlate w/ K level 

 • Treat if EKG changes, K > 6.5, or rapid rise

 • Key is elimination, other measures are temporizing. Address reversible factors (optimize volume status, low K diet, meds)

Stabilize

 • Calcium: calcium gluconate or CaCl2 1-2 g IV, can give q5min, Onset 1-3 min, Duration 30-60 min, 1st line if any ECG Δs. Stabilizes cardiac membrane. Avoid if on dig

Redistribute

 • Bicarb (sodium bicarbonate 1-2 amps IV vs gtt)*, Onset 5-10 min, Duration 1-2 hr, Drives K into cells. Only if ↓↓ pH

 • Insulin (10 units IV) + Glucose (D50, if BS<250), Onset 10-30 min, Duration 4-6 hr, Drives K into cells. ↓K 0.5-1.5 mEq/L

 • Albuterol (10-20mg neb preferred over IV), Onset 15-30 min, Duration 15-90 min, Drives K into cells. ↓K 0.5-1.5 mEq/L

Eliminate

 • Furosemide (≥40mg IV), Onset 30 min, Duration Variable, Urinary K excretion

 • Kayexalate (15-30g PO/PR)**, Onset 1-2 hr, Duration 4-6 hr, Swap K for Na in gut

 • Hemodialysis (definitive Rx)***, Onset Immediate, Duration 3 hr, Removes K, may rebound d/t shifts



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