Table 1.

Acute treatment of hyperkalemia in the emergency department

THERAPYDOSEONSETDURATION, HRESPONSE
Calcium chloride or calcium gluconate10 mL of IV 10% solution1–3 min0.5–1Stabilizes cardiac membranes
Insulin and glucose10 units in 50 mL of 50% dextrose15–30 min1–2Shifts potassium into cells. Decreases serum potassium level by 0.6–1 mmol/L at 1 h4
Salbutamol0.5 mg of IV salbutamol or 20 mg of nebulized salbutamol15–30 min4–6Shifts potassium into cells. Decreases serum potassium level by 0.3–0.6 mmol/L at 30 min4
Sodium bicarbonate*150 mEq of sodium bicarbonate with 1 L of 5% dextrose in water60 minVariableShifts potassium into cells
Cation-exchange resins†25–50 g, oral or rectal administration2 h4–6GI excretion
Furosemide40 mg IVDepends on the cause of hyperkalemiaVariableRenal potassium excretion

  • GI—gastrointestinal, IV—intravenous.

  • ↵* Sodium bicarbonate is only effective in an acidemic state.5,6

  • ↵† If dialysis not readily available.7