Management of hyperkalemia

1. Hyperkalemia
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2. Hyperkalemia:
• Serum potassium level >5.5 mmol/L

3. Severity of hyperkalemia
 Mild: K level <6.0 mmol/L maybe normal or show
only peaked T waves
 Moderate: K level 6.0 – 7.0 mmol/L (+) ECG may
show peaked T waves
 Severe:
• 7 – 8 mmol/L: (+)flattening of P waves & QRS
widening;
• 8 – 9 mmol/L: reveals fusion of QRS w/ T wave
that leads to AV dissociation, ventricular
dysrhythmias and death

4. Management of Hyperkalemia
Step 1: Stabilization of membrane potential
o Ca Chloride/ Ca Gluconate 10%: 10-20mL IV
over 3-10min
o Note: use only when there is ECG evidence of
hyperK, significant neuromuscular weakness
or serum K >7mmol/L

5. Step 2. shift ECF K into ICF
o Administer Dextrose/Insulin: 40-50 mL D50W
IV over 5-10 min & 10 units HR
o Administer Na Bicarbonate 1meq/Kg IV as
bolus over 5min in patient w/ moderate to
severe metabolic acidosis
Note: most useful in severely acidotic patient
o Salbutamol 5 mg + 3-4mL saline: nebulize over
10 min; use w/ caution in IHD

6. Step 3. Remove K from the body
o Resonium A: 15gms PO 4-6 hourly
o Hemodialysis
Step 4. Prevent further K increase
o Review al medications: Span K, ACEI,B
Blockers
o Dietary review and advice

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