Treatment of hyperkalemia

Irrespective of the cause, the primary goals are reduction of plasma potassium towards the safe range and myocardial protection if required. Secondary goals are the correction of coexisting metabolic disturbances and treatment of the underlying cause. It is usual to start trying to correct plasma potassium at levels above 5.5 mmol/l. Treatment should include stopping drugs that promote potassium retention and reviewing potassium intake in feeds and infusions. At levels above 6.5 mmol/l, aggressive measures should be adopted to reduce potassium whilst calcium salts should be given if there are cardiac arrhythmias or broadening of the QRS complex. Temporary short-term control is achieved most effectively by promoting potassium shifts into cells (A!!.odJ...9.9.3); these methods all require 15 to 30 min to take effect (Lens., ..1989). Longer-term control involves promoting increased potassium excretion.

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