Hypoglycemia occurred most frequently between 60 and 150 min, with a peak at 90 min. The prevalence of diabetes was 60%, and 70% had chronic kidney disease (eGFR < 60 ml/min/1.73 m 2). The mean age was 70 years with 62% male predominance. In a retrospective cohort study in a tertiary hospital network, we included 421 adult patients with a serum potassium ≥ 6.0 mmol/L who received insulin-dextrose treatment. We aimed to determine the factors associated with hypoglycemia (glucose < 3.9 mmol/L, or < 70 mg/dL) and the critical time window with the highest incidence. *** Don’t use Kayexalate on a long-term basis because cation resins like Kayexalate can cause severe side effects, particularly intestinal necrosis, which may be fatal.Treatment of hyperkalemia with intravenous insulin-dextrose is associated with a risk of hypoglycemia. Calcium gluconate is the preferred drug because calcium chloride often causes local irritation at the injection site. It stabilizes the cell membranes and is indicated to prevent arrhythmias in patients with hyperkalemia and EKG changes.Ĭalcium chloride contains three times the concentration of elemental calcium compared with calcium gluconate (13.6 versus 4.6 meq in 10 mL of a 10 percent solution. Note: Intravenous calcium gluconate solution does not lower serum potassium. Decreases total body K via renal excretion. Decreases total body K by exchanging Na for K in the GI tract. Kayexalate 15 to 30 g PO / PR (retention enema) The effect is transient as well and may last 2 hours.ĭecrease total body Potassium / Promote potassium excretion This is 4 to 8 times the dose used for bronchodilation. Maybe less effective for patients with ESRDĪlbuterol 10 to 20mg in 4ml of saline given nebulized over 10 minutes. ![]() Give especially if the patient is acidemic. The effect is also transient, lasting about 60 minutes. Sodium bicarbonate 50 mEq IV over 5 minutes To avoid hypoglycemia (which is common) after giving the insulin bolus, start the patient on an infusion of 10 % dextrose at 50 to 75 mL/hour and closely monitor of blood glucose levels every hour for five to six hours. Repeat dose after five minutes if the ECG changes persist or recur.Ĭalcium gluconate is generally preferred because calcium chloride may cause local irritation at the injection site. The effect is transient, lasting 30-60 minutes. *Calcium chloride 500 to 1000 mg (5 to 10 mL of a 10% solution), also infused over 2-3 minutes TreatmentĬalcium gluconate 1000 mg (10 mL of a 10% solution) IV infused over 2-3 minutes OR ![]() ![]() Promote potassium excretion: Furosemide, Kayexalate, and dialysis. Shift potassium into cells: Sodium bicarbonate Glucose PLUS insulin Nebulized albuterol. In order of priority, treatment includes the following: ![]() Therapies that shift potassium will act rapidly but they are temporary if the serum potassium rebounds you may need to repeat those therapies. For mild elevation (5 to 6 mEq/L), remove potassium from the body with Furosemide and Kayexalate.įor moderate elevation (6 to 7 mEq/L), shift potassium intracellularly with Glucose plus insulin, Sodium bicarbonate, and Nebulized albuterolįor severe elevation (>7 mEq/L with toxic ECG changes), you need to shift potassium into the cells and eliminate potassium from the body.
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