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 | ||