Hyperkalemia is an elevated level of potassium in the blood above 5.5 mmol/L. Initial treatments include calcium gluconate to protect the heart, insulin with glucose to shift potassium into cells, salbutamol to also shift potassium into cells, sodium bicarbonate to treat acidosis, and sodium polystyrene sulphonate to bind potassium in the gut. Definitive treatment is hemodialysis to remove excess potassium from the blood. The emergency management involves determining the cause and using temporary treatments to stabilize the heart and lower potassium through redistribution while arranging hemodialysis if needed for severe cases.

1. HYPERKALEMEA
MANAGEMENT
MEDICATIONS

2. • Hyperkalemia is an elevated level of
potassium (K+) in the blood serum.[1] Normal
potassium levels are between 3.5 and 5.0
mmol/L
• Levels above 5.5 mmol/L defined as
hyperkalemia

5. • Initial management
Treatment options include calcium (Ca)
gluconate, insulin with glucose,
salbutamol, sodium bicarbonate
(NaHCO3) and sodium (Na) polystyrene
sulphonate.
Definitive management is hemodialysis

6. CALCIUM GLUCONATE
• Calcium((either gluconate or chloride) is given
intravenously to protect the heart, but calcium does not
lower the potassium level.
• Inj.Calcium gluconate 10% 10 ml diluted in 10 ml normal
saline-administer over 10 minutes
• Hyperkalaemic patients taking digoxin
should be given calcium as a slow infusion
over 20 to 30 minutes. This avoids
hypercalcaemia that may potentiate the
myocardial toxicity of digitalis.

7. INSULIN WITH GLUCOSE
• Insulin administered with glucose: Facilitates
the uptake of glucose into the cell, which results
in an intracellular shift of potassium
• 50%Dextrose is a carbohydrate, which is one part
of nutrition in a normal diet. ... When the cells take
in the extra glucose, they also take in potassium.
This helps to lower a person's blood potassium
levels. The dextrose is given to prevent the person
from being hypoglycemic.
• Dextrose 50 % 50 ml+ actrapid 10 units
administered over 30 minutes.

8. SALBUTAMOL
• Ventolin is an adrenergic agonist that has an
additive effect with insulin and glucose, which may
in turn help shift potassium into the intracellular
space.
• This agent lowers the serum potassium level by
0.5-1.5 mEq/L. It can be very beneficial in patients
with renal failure when fluid overload is concern

9. SODIUM BICARBONATE
• It has no significant action on plasma K in the first
60 minutes after administration.
• It may be indicated in severe metabolic acidosis (pH
<7.2),which may be an associated feature in ARF.
• Potential risks in giving NaHCO3 include
hypernatraemia, volume overload and tetany in
patients with CRF and coexistent hypocalcaemia

10. SODIUM/CALCIUM
POLYSTYRENE SULPHONATE
(Resonium)
• This resin binds K in the intestinal lumen, especially
large bowel and ileum-it increases faecal K
excretion
• It may be indicated if haemodialysis is delayed (>2–
3 hours).

11. HAEMODIALYSIS
• This is the definitive and most effective
hypokalaemic measure.
• It is indicated in severe hyperkalaemia. Mild to
moderate hyperkalaemia in CRF may be managed
without haemodialysis as an emergency depending
on the cause.

12. CONCLUSION
• The emergency management involves (1) determining the
cause and (2) instituting temporising measures to
stabilise the myocardium and lower the plasma K by
redistribution to the intracellular compartment while
arranging haemodialysis if necessary.
• Moderate to severe hyperkalaemia in the emergency
department should be treated with
• (1) Ca gluconate if there are any ECG changes followed
by
• (2) insulin with glucose and
• (3) intravenous salbutamol (nebulised if there is evidence
of ischemic heart disease).
• NaHCO3
• Sodium polystyrene sulphonate can be given if there is an
anticipated delay in haemodialysis