Management

Potassium restriction is needed for all cases and haemodiafiltration or haemodialysis may be needed for resistant cases.

Cardiac arrest associated with hyperkalaemia

Sodium bicarbonate (8.4%) 50-100 ml should be given in addition to standard CPR and other treatment detailed below.

Potassium >7 mmol/l

Calcium chloride (10%) 10 ml should be given urgently in addition to treatment detailed below. Although calcium chloride does not reduce the plasma potassium, it stabilises the myocardium against arrhythmias.

Clinical features of hyperkalaemia or potassium >6 mmol/l with ECG changes

Glucose (50 ml 50%) and soluble insulin (10 iu) should be given IV over 20 min. Blood glucose should be monitored every 15 min and more glucose given if necessary. In addition, calcium resonium 15 g qds PO or 30 g bd PR can be considered.

P.421

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