Sodium Bicarbonate for Hyperkalemia in the Emergency Department

Introduction Sodium bicarbonate was previously recommended for hyperkalemia treatment and was once considered a first-line agent for transcellular shift. Studies evaluating the beneficial effects of sodium bicarbonate used an isotonic infusion commonly  ~ 150 mEq/ 1000ml Hypertonic sodium bicarbonate or “amp of bicarb” has an osmolality of 2000 mOsm, about 7x higher than plasma. There’s […]

Management of Hypokalemia in Cardiac Arrest

Download PDF Introduction Severe hypokalemia may precipitate profound and life-threatening cardiac complications including arrhythmia and asystole. Classical teaching is that in cardiac arrest with non-shockable rhythms the management include to identify and treat the H’s & T’s which include hyper and hypokalemia. Potassium chloride is the therapy of choice, however, the dose and administration of […]

Insulin for HyperKalemia in Renal Insufficiency

Introduction  • Insulin with dextrose is an effective method to lower potassium levels quickly in acute hyperkalemia.  • Literature shows ranges of potassium reduction by 0.5-1.0 mEq after administration of a single dose.  • Patients with renal insufficiency and end stage renal disease (ESRD) have a higher incidence of  hypoglycemia after treatment with insulin for […]

Kayexalate and Lokelma For the Management of Hyperkalemia

Introduction 1.     Hyperkalemia is defined by a serum or plasma potassium level > 5 mEq/L  2.         Elevated potassium (K) levels may present with: a. Electrocardiographic (ECG) changes causing life-threatening arrythmias, AND/OR b. Muscle weakness or paralysis  Hyperkalemia may be caused by increased K intake, intracellular K shifts, or impaired K excretion Neuromuscular weakness, […]