Hyperkalemia Management

Mnemonic: C BIG K!!
Watch out for other complications of rhabo, especially Hyperkalemia - can cause peaked T waves, prolongation of QRS and PR interval, progression to sine waves, and cardiac arrest.

• Calcium gluconate – for immediate cardiac membrane stabilization.  Transient effect, lasts ~30-60 minutes only.  Note that Calcium chloride has 3x more calcium than gluconate, but is sclerosing and must be given through a central line.
• B2 agonists (Albuterol nebs) – drives K into cells. 
• Bicarbonate – efficacy less clear, but again through driving K into cells (H+/K+ pump on cell membrates).
• Insulin + Glucose – give 10 units IV insulin + 1 amp of D50 (to prevent them bottoming out with hypoglycemia) – goal is to drive K into cells
• Kayexalate – resin that binds K in the gut and removes it  a BM.  This is the only treatment out of those listed that actually removes K from the body.

Diuretics are not part of the mnemonic but should be.  Of course, hemodialysis is always a last resort option.

(Chanu Rhee MD, 10/14/10)