Treatment of Hyperkalemia Treatment of Hyperkalemia

Flowchart

Is Life-Threatening Hyperkalemia Present?
ECG Changes?
High Risk (Renal Failure, Receiving Dialysis, Causative Medications)
Serum Potassium >6.5 mEq/L Yes Yes No No Is Life-Threatening Hyperkalemia Present?
ECG Changes?
High Risk (Renal Failure, Receiving Dialysis, Causative Medications)
Serum Potassium >6.5 mEq/L


Yes Yes Yes Yes No No No No Is Life-Threatening Hyperkalemia Present?
ECG Changes?
High Risk (Renal Failure, Receiving Dialysis, Causative Medications)
Serum Potassium >6.5 mEq/L Is Life-Threatening Hyperkalemia Present?
ECG Changes?
High Risk (Renal Failure, Receiving Dialysis, Causative Medications)
Serum Potassium >6.5 mEq/L


Yes Yes No No Yes Yes Yes Yes No No No No No No Resin Exchange with
Laxative Resin Exchange with
Laxative
Is Urine Output Present? Yes Yes No No Is Urine Output Present? Yes Yes Yes Yes No No No No Yes Yes Attempt Loop Diuretic Such as
Furosemide (80–240 mg) Attempt Loop Diuretic Such as
Furosemide (80–240 mg)
No Response No Response Hemodialysis Hemodialysis No No Yes Yes Step 1: Stabilize the Myocardium Step 1: Stabilize the Myocardium IV Calcium Chloride or IV
Calcium Gluconate
10 mL (1 Ampule) of 10% Solution IV Calcium Chloride or IV
Calcium Gluconate
10 mL (1 Ampule) of 10% Solution

Consider Repeating if ECG Changes Persist Consider Repeating if ECG Changes Persist Step 2: Shift Potassium into Cells Step 2: Shift Potassium into Cells IV Humulin R (10-20 U)
IV Glucose (25-50 g)
Repeat Glucose measurements Every 20 min IV Humulin R (10-20 U)
IV Glucose (25-50 g)
Repeat Glucose measurements Every 20 min

Nebulized Salbutamol (10-20 mg) or
Salbutamol via MDI (0.18 mg) Nebulized Salbutamol (10-20 mg) or
Salbutamol via MDI (0.18 mg)
Step 3: Enhance Elimination of Potassium Step 3: Enhance Elimination of Potassium Patient's Volume Status Patient's Volume Status Resin Exchange with
Laxative Resin Exchange with Laxative Patient's Volume Status Patient's Volume Status Patient's Volume Status Patient's Volume Status Resin Exchange with
Laxative Resin Exchange with Laxative Resin Exchange with
Laxative
Resin Exchange with Laxative Patient's Volume Status Patient's Volume Status Low Low Normal or High Normal or High Low Low Low Low Normal or High Normal or High Normal or High Normal or High Low Low Attempt Volume Resuscitation with
0.9% NaCl, if Clinically Indicated Attempt Volume Resuscitation with
0.9% NaCl, if Clinically Indicated
Normal or High Normal or High