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. | None |
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). | None |
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 |