Hyperkalemia

Repeat K to be sure is not due hemolysis. Discontinue any K containing fluid or TPN.

  1. For the asymptomatic patient with a Serum K+ of 5.5-7.0 mEq/L.
    1. Furosemide 1-2 mg/kg IV once over 2 minutes, max one time dose=40mg.
    2. Monitor blood pressure and urine output
  2. For the symptomatic patient (EKG abnormalities and symptoms of cardiovascular compromise) or Serum K+ 7.0 or above.
    1. Monitor for bradycardia or heart block
    2. Calcium Gluconate 10% solution slow IV push once over 5 minutes
      1. 0.6 ml/kg (60 mg/kg) Max single dose of 10 ml (1000 mg)

      OR


    3. Calcium Chloride slow IV (prefer central line) push once over 5 minutes
      1. 0.2ml/kg (20 mg/kg) Max single dose of 10 ml (1000 mg)
    4. Insulin: 1 unit of Regular Insulin for every 50ml of Dextrose 10%
    5. Dextrose 10% 5ml/kg; Max dose of 25g
    6. Sodium Bicarbonate 0.5-1mEq/kg, Max dose of 50 mEq
      1. Indicated if the patient has metabolic acidosis
      2. Monitor for proper ventilation controlling serum CO2 & pH
    7. Nebulized Albuterol 5 mg once

Citations/References:

  1. Lenhardt A and Kemper MJ. Pathogenesis, diagnosis and management of hyperkalemia. Pediatr Nephrol. 22 December 2010

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