Patients with Ebola virus disease can develop severe hyperkalaemia — defined as a serum potassium exceeding 6.5 mmol/L or the presence of hyperkalaemia-associated ECG changes. This complication carries a high risk of life-threatening arrhythmia and requires prompt structured management.
Management prioritises immediate cardiac membrane stabilisation as the first step, followed by a staged series of interventions to redistribute and facilitate removal of excess potassium — with escalation options for refractory presentations available within the full protocol.
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.
View source ↗