Therapy

• no ECG changes: monitor the patient and correct the cause
• consider using resins to prevent worsening if no other way to increase K output (e.g. oliguric patient)

• Give 10 ml of 10% calcium gluconate if urgent correction is required (e.g. haemodynamic instability, significant ECG changes) ^d
• Give 20 ml of 50% glucose iv and short-acting insulin 10 units iv as an iv bolus ^c  
• Consider adding salbutamol 10 - 20mg by nebuliser ^c  
• Consider combining with hypertonic sodium bicarbonate at 2 mmol/ min for one hour. ^b  
• Correct the cause ^d
• Monitor the serum potassium, and repeat therapy if necessary ^d

The above agents promote shift within the body and only have a temporary effect. ^d

If unable to reverse underlying condition or promote potassium excretion (e.g. acute renal failure, oliguria), or hyperkalaemia persists:

• Give sodium polystyrene sulphonate or calcium polystyrene sulphonate (calcium resonium) 30-60 g by mouth, combined with lactulose.^d
• Avoid using resins combined with sorbitol because of the rare complication of intestinal necrosis ^d
• If unable to give a resin by mouth or nasogastric tube, and there is no lower GI pathology absent, give as a retention enema.

Refer ^.for dialysis if hyperkalaemia persists or renal function is poor. ^a