Basic Concepts of Fluid and Electrolyte Therapy

Immediate treatment
iv 10 ml 10% calcium gluconate over 2-5 minutes (cautiously,
as extravasation can cause tissue damage). This stabilises
the myocardium rapidly, but has no effect on serum potassium
concentration. Further doses may be required until
reduction in plasma potassium concentration is achieved.
Onset of action 2-4 minutes. Duration of action 30-60 minutes.
Further treatment
10 u fast acting insulin (actrapid) added to 50 ml of 50%
dextrose infused iv over 20 minutes to increase cellular
potassium uptake. Blood glucose must be monitored closely.
Onset of action 15-30 minutes. Duration of action 4-6
hours.
5 mg salbutamol nebuliser (up to a maximum of 10-15 mg
back to back) to stimulate cellular potas sium uptake. Avoid
in patients on beta blockers and/or who have a history of
cardiac arrhythmias. Onset of action 30 min utes. Duration of
action 2-4 hours.
Medication review - stop any drugs that contain potassium
or interfere with renal excretion of potassium (ACE inhib -
itors, angiotensin receptor blockers, beta-blockers, potassium
sparing diuretics)
Review potassium intake including intravenous fluids and
enteral or parenteral feeds
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