Published in:
01-06-2009 | Guidelines
Chapter 23. Treatment of hyperkalemia and metabolic acidosis
Published in: Clinical and Experimental Nephrology | Issue 3/2009
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Table 23-1
Emergency treatment of hyperkalemia: CKD stage 3 and over
|
Measures
|
Effect
|
Example of the treatment
|
|---|---|---|
|
Ca gluconate, iv
|
Cardiac protection
|
Ca gluconate 10 mL, 5 min, iv
|
|
Loop diuretics, iv
|
Increase the urinary excretion
|
Furosemide 20 mg + saline 20 mL
|
|
NaHCO3
|
Shift into cells
|
7% NaHCO3 20 mL, iv
|
|
Glucose-insulin
|
Shift into cells
|
10 g of glucose with 1 unit insulin, div. No glucose if hyperglycemia
|
|
Cation exchanger resin
|
Removal
|
30 g, dissolved in 100 mL warm water, then given into rectum, and left for 1 h
|
|
Hemodialysis
|
Removal
|
3 h or longer depending on the plasma K
|
-
As CKD stage progresses, metabolic acidosis develops and serum potassium (K) increases.
-
In case of severe hyperkalemia, ECG recording should be performed to evaluate the emergency.
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A hyperkalemic patient with abnormal ECG findings should be treated as emergency and be consulted with nephrologists thereafter.
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The causes of hyperkalemia in CKD are mainly due to drugs such as ACE inhibitors, ARBs, spironolactone, etc. and to excess of potassium-rich diet (Table 23-1).