Back to Basics: Hyperkalemia Management

Hyperkalemia Treatment Options

By: Lou Argentine

Remember, when you see a big K+, give "C BIG K"! (+ a few other options...)


1000 mg calcium gluconate (10mL of 10% solution) or 500-1000 mg calcium chloride (5-10mL of 10% solution) given over 5-10 minutes

- Stabilizes the cardiac membrane

- Effect within minutes, only lasts 30-60 minutes, dose should be repeated every 30-60 minutes

- Calcium chloride contains x 3 the concentration of elemental calcium

- Central access is preferred for calcium chloride - irritation, tissue necrosis with extravasation

Sodium Bicarbonate

50-150 mEq sodium bicarbonate IV

- Shifts potassium into cells by causing relative alkalemia

- Effect begins within 5-10 minutes, duration 1-2 hours

Insulin with Glucose

10 units regular insulin IV with 25-50 grams dextrose (1-2 ampules of D50)

- Insulin drives potassium into the cells, glucose given to prevent hypoglycemia

- Effect of insulin begins 10-20 minutes after infusion, duration 4-6 hours

- Expect potassium to drop 0.5-1.2 mEq/L

Gastrointestinal Cation Exchanger

25-50 grams sodium polystyrene sulfonete (kayexylate) PO or PR

- Binds potassium in GI tract in exchange for other cations

- 1-2 hour onset of action


10-20mg albuterol nebulized over 10 minutes

- Shifts potassium into cells

- Effect begins within 15-30 minutes, duration 2-4 hours

Loop Diuretics

40-80mg IV furosemide

- Increases potassium loss in urine

- Onset/duration of action varies based on renal function


IV Normal Saline

- Hydration with isotonic normal saline will both dilute serum potassium and promote renal excretion of potassium


- Removes potassium within minutes



Jones KM, Wood SL, Chiu WC. Critical Care Emergency Medicine. 2nd ed. New York, NY: McGraw-Hill Education LLC, 2017.

Tintinalli JE, Stapczynski JS, Ma OJ, Yealy DM, Meckler GD, Cline DM. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 8th ed. New York, NY: McGraw-Hill Education LLC, 2016.