DR Medhat MRCP

o Treatment of hyperkalemia :
1. I.V Ca gluconate :
- If K + mmol/L OR ECG changes.
- Membrane stabilizer i.e antagonize membrane effect of hyperkalemia.
- 10 ml ca-gluconate 10%(one ampule contains 220 micromols of ca) slowly I.V
- Repeat if no ECG improvement after 5 minutes (up to 40 ml ca-gluconate)
- Since ca ++ can induce digitalis toxicity , so,in patients taking digxin initially
هام جدا slowly. give ½ the dose of ca-gluconate & give it more
2. Dextrose – insulin therapy :
- If K + mmol/L OR ECG changes.
- 10-15 units actrapid in 50 ml of dextrose 50% over 10 minutes.
- Shifts the K + intracellulary through activity of Na-K ATPase membrane pump
- Expect effect within maximum 1 hour ( K + by 0.5-1.5 mmol/L).
- Repeat every 4 hours till K < 5.5 mmol/L.
- Nebulized salbutamol (B-agonist) has the same action, so better not to give
with dextrose-insulin to avoid it side effects e.g tachyarrhythmias.
3. Na-bicarbonate :
- If hyperkalemia is associated with metabolic acidosis (HCO3 6.5 mmol/L refractory to medical ttt (e.g ARF).
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