Treatment of Hyperkalemia-hyperkalemia

Ca gluconate Ca chloride

• 1–2 amps IV onset <3 min with
• Transient effect (30–60 min)
• Stabilizes cell membrane

CaCl contains more calcium and is typically reserved for codes (↑ risk of tissue necrosis) or via central line

Insulin

• reg insulin 5–10 U IV + 1–2 amps D50W
• 15–30 min Peak 30–60 min, lasts 4–6 h
• ↓ K 0.5–1.2 mEq/L

Bicarbonate (esp. if acidemic)

• 1–2 amps IV
• 150 mEq in 1 L D5W
• 15–30 min
• Exchange K for H+ in cells
• Lasts 5–6 h; ↓ K 0.7 mEq/L

β2 agonists

• albuterol 10–20 mg inh. or 0.5 mg IV
• 30–90 min
• Peak 90 min, lasts 2–6 h
• ↓ K 0.5–1.4 mEq/L (IV >inh)

K-binding resins

• SPSb 15–60 g PO/PR, patiromer 8.4–25.2 g/d PO, Na zirconium 5–10 g PO
• 4–24 hrs
• Exchange K for cations in gut
• (Na, Ca, H); ↓ K 0.8–1 mEq/L/d.
• Edema & HTN w/ Na zirconium.

~0.4% intestinal necrosis esp. postop, ileus, SBO/LBO, bowel disease (UC), renal txp (Clin Nephro 2016;85:38)

Diuretics

• furosemide ≥40 mg IV
• 30 min
• ↓ total body K

Hemodialysis

Most rapid in 1st hr (1 mEq/L) ↓ total body K (JASN 2017;28:3441)