Treatment of Hyperkalemia

MECHANISM	THERAPY	DOSE	ONSET	DURATION	COMMENTS
Treatment of Hyperkalemia
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.
Cellular K⁺ uptake	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	?	May cause fatal colonic necrosis; if available, sodium zirconium cyclosilicate (ZS-9) or patiromer is preferred to kayexalate.
	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.