![]() ![]() you cannot rely on the ECG to rule out significant hyperkalemia. Prolonged PR interval and flattening of the P wave.The classic ECG progression in hyperkalemia is: If elimination of potassium through the urine is not successful, the patient requires dialysis. Acetazolamide and mannitol are also occasionally used, and can be added for synergistic effect in the patient with life threatening hyperkalemia.80mg IV is my usual starting point, though there is no evidence to guide us.See this PulmCrit post for further discussion. (Of everything discussed, this probably has the strongest evidence. Although saline has traditionally been used to volume resuscitate and promote diuresis, it has actually been shown to induce hypercholermic metabolic acidosis and worsen hyperkalemia. Metabolic acidosis: isotonic sodium bicarbonate (3 amps of bicarb in 1L of D5W).Key question: Can you use the kidneys? In patients with end stage renal disease who cannot excrete potassium renally, dialysis is the only option. (Unlikely to work in patients on beta-blockers) Get the potassium out of the body If less than 4mmol/L (72mg/dL) give 1 amp (50ml) of D50WĪlbuterol 20mg nebulized, may repeat. If starting with a markedly elevated serum glucose (>16mmol/L or 290mg/dL): No initial glucose.If starting with a normal serum glucose: EITHER 2 amps (100ml) of D50W OR 1 amp (50ml) of D50W plus D10W run at 200ml/hr for 2 hours.Make sure to flush after injecting the insulin, because it is a tiny volume that can easily remain in the port or IV tubing.It has been shown to work, but only in patients with hyponatremia and concurrent hyperkalemia Honestly, I am not sure why you would want to choose this over calcium. ![]() Calcium chloride has a higher risk of tissue necrosis if extravasated.Dose can be repeated if there is no improvement ![]() You should see ECG improvement within 3 minutes.
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