Hyperkalemia - Principles of Management

Nice animation of ECG changes during hyperkalemia - this shows clearly that time is life when dealing with severe hyperkalemia.

5 essential principles of management, in simple terms:

1. Protect the heart - IV Ca Gluconate/ Ca Chloride (note contains 3x more calcium) to antagonise the cardiac membrane excitability thereby protect the heart against arrhythmias;

2. Shift K into cells - Insulin/ glucose infusion, nebulised Salbutamol (unlikely to work for patients on non-selective beta-blockers), Sodium Bicarbonate (not for routine use, comes with risk of Na and fluid overload);

3. Remove K from the body - Cation exchange resins (Resonium/ Kalimate, new agents: Patiromer, Zirconium), hemodialysis;

4. Monitor K level - do monitor for rebound hyperkalemia which is common;

5. Prevent recurrence - Do not walk away without knowing the cause of hyperkalemia and to stop further K accumulation, stop ALL potential offending drugs immediately.

Read more at:

CPG of Treatment of Acute Hyperkalemia