Moderate to severe hyperkalemia requires prompt, structured intervention — particularly when ECG changes are present, signalling a risk of cardiac arrhythmia requiring immediate action.
Management begins with protection of cardiac membrane stability in the presence of ECG changes — the subsequent steps and specific agents are detailed in the full protocol.
Rapid control with a serum K+ < 6.0 mmol/L within 2 hours of initiating treatment.
K+ < 6.0 mmol/L within 2 hWe recommend that an equivalent dose (6.8 mmol) of IV calcium is given to patients with hyperkalaemia in the presence of ECG changes at a dose and rate of 30ml 10% Calcium Gluconate over 10 minutes OR 10ml 10% Calcium Chloride over 5 minutes guided by the clinical setting.
We recommend that IV Calcium Chloride is the preferred calcium salt in resuscitation (cardiac arrest or peri-arrest) and IV Calcium Gluconate should be used for all other patients in the presence of ECG signs of hyperkalaemia.
The aim of treatment is to achieve rapid control with a serum K+ < 6.0 mmol/L within 2 hours of initiation of treatment.
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