Ebola virus disease
ICD-10 A98.4 · ICD-11 1D60.0

Treatment of Ebola Virus Disease with Hyperkalaemia (Serum Potassium >6.5 mmol/L or ECG Changes)

Clinical Scenario

This protocol applies to patients with Ebola virus disease (EVD) who develop hyperkalaemia — serum potassium above 6.5 mmol/L or the presence of associated ECG changes.

Why This Complication Is Especially Challenging
Hyperkalaemia is a dangerous complication in EVD, associated with arrhythmias and death. Its management is particularly difficult in outbreak settings: the severe diarrhoea characteristic of the disease limits the use of certain elimination strategies, and dialysis is rarely available.
Treatment Approach
Management centres on intravenous calcium agents as an immediate intervention, alongside further measures for adult and paediatric patients, including an approach for cases that do not respond to initial treatment. Full regimen, dosing pathways, and sequencing are in the complete protocol ↓
Treatment Goal

Improvement of hyperkalaemia-related ECG changes

Instant Access to Structured Evidence-Based Regimens

References

Hyperkalaemia is a dangerous complication that is associated with arrhythmias and/or death and is extremely difficult to manage in EVD outbreaks given that the diarrhoea associated with the disease complicates the use of kayexalate and dialysis is rarely available.

Calcium gluconate 10% 10 ml over 10 minutes (may need one to three ampoules to achieve the same effect as calcium chloride); or calcium chloride 10% 5–10 ml IV over 10 minutes, repeat if necessary until ECG changes improve.

Insulin: administer IV 10 units Humulin R insulin with two ampoules 50% glucose.

Bicarbonate IV 50 mEq slow push over 2 minutes.

Consider use of sodium polystyrene sulfonate 15 or 30 g once and can repeat every 8 hours in patients WITHOUT copious diarrhoea.

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