Guidelines for Treatment of Adult Patients With Hyperkalemia






First: Stop all infusion of potassium.

 Electrocardiographic Evidence of  Pending Arrest


 Loss of P wave and broad slurring of QRS; immediate effective therapy indicated 

 1. IV infusion of calcium salts 10 mL of 10% calcium chloride during a 10-minute period or 10 mL of 10% calcium gluconate during a 3- to 5-minute period 

 2. IV infusion of sodium bicarbonate 50-100 mEq during a 10- to 20-minute period; benefit proportional to extent of pretherapy acidemia

 Electrocardiographic Evidence of  Potassium Effect 

 Peaked T waves; prompt therapy needed

 1. Glucose and insulin infusion IV infusion of 50 mL of D50W and 10 units of regular insulin; monitor glucose 

 2. Immediate hemodialysis

 Biochemical Evidence of Hyperkalemia and No Electrocardiographic Changes

 Effective therapy needed within hours 

 1. Potassium-binding resins into the GI tract, with 20% sorbitol

 2. Promotion of renal kaliuresis by loop diuretic

 see also: 

Potassium Deficits in Hypokalemia.


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