Hyperkalaemia
caution
Discuss all dialysis or renal transplant patients with the Renal SpR (#45626).
Discuss unstable patients or those with multi-organ failure with senior and escalate as appropriate.
If hyperkalaemia is refractory to treatment or ECG changes persist, discuss with local ITU.
Treatment​
Start with ABCDE assessment and identify risk factors for arrhythmia, including potentia rate of rise in serum potassium (e.g. rhabdomyolysis, tissue necrosis or oliguric renal failure). Perform 12-lead ECG if K ≥ 6.0.
Protect the heart​
If required, administer 30 mL calcium gluconate 10% neat over 5 minutes via a large peripheral vein with continuous cardiac monitoring.
If a large vein is unavailable, administer over 10 minutes and watch for extravasation.
Administer over 30 minutes if there are concerns about digoxin toxicity.
info
30mL calcium gluconate is the dose recommended in the national guidance.
An alternative is 10mL 10% calcium chloride over 5 - 10 minutes.
Repeat dose after 5 minutes if ECG changes persist. This can be repeated after 5 minutes. Effects are transient (30 - 60 minutes).
If extravasation occurs contact Plastics at RLH via switchboard.
caution
Do not administer sodium bicarbonate simultaneously via same access (risk of formation of insoluble calcium salts) or mix with any other drugs (risk of incompatibility).
Shift K+ into cells​
Administer 8 units of Actrapid insulin in 100 mL of 20% glucose over 15 minutes. Effects peak at 30 - 60 minutes and last for up to 6 hours.
If 20% glucose is unavailable, administer 10 units of Actrapid insulin in 50 mL of 50% glucose. This can be given over 15 minutes but must be given via central venous access device as venous irritation and tissue damage may occur in cases of extravasation.
caution
Do not give glucose in DKA if CBG ≥ 20 mmol/L. Give insulin only.
Administer 10 - 20 mg of nebulised salbutamol (10 mg in patients with IHD, severe tachycardia). In combination with insulin-glucose, salbutamol can lower serum potassium by an additional 0.5 - 1.0 mmol/L. Effects last up to 2 hours. Nebulised salbutamol may not be effective, especially in patients taking beta-blockers or digoxin, and should only be used as first-line treatment while awaiting IV access for insulin-glucose.