|Calcium ||Antagonizes cardiac conduction abnormalities ||0–5 minutes ||1 hour ||Calcium gluconate 10%, 5–30 mL intravenously; or calcium chloride 5%, 5–30 mL intravenously ||None |
|Bicarbonate ||Distributes K+ into cells ||15–30 minutes ||1–2 hours || |
NaHCO3, 50–100 mEq intravenously
Note: Sodium bicarbonate may not be effective in end-stage kidney disease patients; dialysis is more expedient and effective. Some patients may not tolerate the additional sodium load of bicarbonate therapy.
|Insulin ||Distributes K+ into cells ||15–60 minutes ||4–6 hours ||Regular insulin, 5–10 units intravenously, plus glucose 50%, 25 g intravenously ||None |
|Albuterol ||Distributes K+ into cells ||15–30 minutes ||2–4 hours || |
Nebulized albuterol, 10–20 mg in 4 mL normal saline, inhaled over 10 minutes
Note: Much higher doses are necessary for hyperkalemia therapy (10–20 mg) than for airway disease (2.5 mg).
|Nonemergent/Excretory Therapy |
|Modality ||Mechanism of Action ||Onset of Action ||Prescription ||K+ Removed From Body |
|Loop diuretic ||Renal K+ excretion ||0.5–2 hours ||Furosemide, 40–160 mg intravenously ||Variable |
|Patiromer ||Ca2+-K+ cation exchange resin ||∼7 hours ||Oral: 4.2–16.8 g once or twice daily ||Mean 0.75 mEq/L |
|Sodium circonium cyclosilicate ||Selective potassium cation trapping agent ||1 hour ||Oral: 10 g up to three times daily ||0.7 mEq/L per 10g dose |
|Sodium polystyrene sulfonate (eg, Kayexalate) ||Ion-exchange resin binds K+ ||1–3 hours || |
Oral: 15–60 g in 20% sorbitol (60–240 mL)
Rectal: 30–60 g in 20% sorbitol
Note: Resins with sorbitol may cause bowel necrosis and intestinal perforation, especially in patients with abnormal bowel function.
|0.5–1 mEq/g resin |
|Hemodialysis1 ||Extracorporeal K+ removal ||1–8 hours ||Note: A fast and effective therapy for hyperkalemia, hemodialysis can be delayed by vascular access placement and equipment and/or staffing availability. Serum K can be rapidly corrected within minutes, but post-dialysis rebound can occur. ||25–50 mEq/h |
|Peritoneal dialysis ||Peritoneal K+ removal ||1–4 hours ||Frequent exchanges ||200–300 mEq |