Treatment of Hyperkalemia
| Mechanism | Therapy | Dose | Onset | Duration | Comments |
|---|---|---|---|---|---|
| Stabilize membrane potential | Calcium | 10% Ca gluconate, 10 mL over 10 min | 1-3 min | 30-60 min | Repeat in 5 min if persistent electrocardiographic changes; avoid in digoxin toxicity. |
| Cellular K+ uptake | Insulin | 10 U R with 50 mL of D50, if blood sugar <250 | 30 min | 4-6 h | Can repeat in 15 min; initiate D10W IV at 50-75 mL/h to avoid rebound hypoglycemia. |
| β2-Agonist | Nebulized albuterol, 10-20 mg in 4-mL saline | 30 min | 2-4 h | Can be synergistic/additive to insulin; should not be used as sole therapy; use with caution in cardiac disease; may cause tachycardia/hyperglycemia. | |
| K+ removal | Kayexalate | 30-60 g PO in 20% sorbitol | 6 h | ? | For sustained efficacy may need more than one dose. May cause fatal colonic necrosis, particularly in enema form and postoperative state. |
| Furosemide | 20-250 mg IV | 15 min | 4-6 h | Depends on adequate renal response/function. | |
| Hemodialysis | Immediate | Efficacy depends on pretreatment of hyperkalemia (with attendant decrease in serum K+), the dialyzer used, blood flow and dialysate flow rates, duration, and serum to dialysate K+ gradient. |