Guidelines for Treatment of Adult Patients With Hyperkalemia
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
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