Hyperkalaemia – Management

Continuous cardiac monitoring  Look for Hyperakalaemic ECG changes

1. Immediate antagonism of the cardiac effects of hyperkalemia.

10 mL of 10% calcium gluconate infused intravenously over 2 to 3 min with

cardiac monitoring
(dose should be repeated if there is no change in ECG findings or if they recur after initial
improvement)

2. Rapid reduction in plasma K + concentration by redistribution into cells .

 10 units of IV regular insulin followed immediately by 50 mL of 50%

dextrose.
( 10 to 20 units of regular insulin in 500 mL of 10 percent dextrose, given intravenously over 60
minutes )

 10–20 mg of nebulized Salbutamol in 4 mL of normal saline, inhaled

over 10 min

3. Removal of Sodium from body

 Low potassium Diet

 Cation exchange resin - Sodium polystyrene sulfonate (SPS)- 15-
30g
 Loop & Thiazide Diuretics
( SPS should not be administered in patients at higher risk for intestinal necrosis, including
postoperative patients, patients with a history of bowel obstruction, patients with slow intestinal transit,
patients with ischemic bowel disease and renal transplant patients. Loop and thiazide diuretics can
be utilized to reduce plasma K + concentration in volume-replete )
 Dialysis

Drop of Physiology - Calcium raises the action potential threshold and reduces excitability without changing the
resting membrane potential.