How to treat acute hyperkalemia? Acute treatment recommendations are summarized in these steps:
|Antagonizes the effects of potassium at the level of cell membranes and stabilizes the membrane potential|
|Calcium salts (calcium gluconate 10%)||10 mL over 2-5 minutes IV||Onset of action: a few minutes.||Effect of duration: 30 to 60 minutes|
|Promotes the entry of potassium into the cells|
|Glucose + insulin administration||10 U rapid insulin in 50g glucose (500 mL 10% or 50 mL 50%) IV||Onset of insulin action: 30 to 60 minutes||Effect duration: 6 to 8 hours|
|Use of beta-adrenergic agonists (salbutamol)||-0.5 mg in 100 mL of 5% glucose over 15 min IV|
-10-20 mg (2-4 ml) in nebulization in 10 minutes
|Start of Beta2 action: |
-30 minutes (IV).
-90 minutes (nebulized)
|Effect duration: 2 to 3 hours|
|Sodium bicarbonate (reserved only for those cases with concomitant metabolic acidosis)||Bicarbonate 1/6 M, 250-500 mL or 50 mL of 1M IV||Onset of action: 30 to 60 minutes||Effect duration: 6 to 8 hours|
|Promote the elimination of calcium from the body|
|Loop diuretics (Furosemide)||40 to 20 mg IV depending on renal function. |
Useful in cases where there is no severe renal failure.
|Onset of action: 30 minutes||Effect duration: hours|
|Ion Exchange Resins (Sodium Polystyrene Sulfonate)||Oral: 15-50g/4-6 hours (3-6 spoons dissolved in water)|
Enema: 30-100 g/4-6 hours (diluted in 250 ml)
|Onset of action: 1 hour||Effect duration: 12 hours|
|Dialysis||When the previous measures were insufficient or potassium levels continue to increase.|
It is preferred for its speed.
It is able to remove 25-50 ml/hour