for chronic dialysis patients seek expert advice

K+ 7.0 mmol/L

Immediate Treatment

K+ 6.0 - 6.9 mmol/L + ECG changes

Immediate Treatment

K+ 5.3 - 5.9 mmol/L

RECHECK +/- ENTERAL TREATMENT

E C G

Tented T-wave

Broad QRS

CHANGES

Flattened / absent P-wave

Immediate Treatment

 

STOP any potassium supplements (iv/po)

 

GIVE 10ml 10% calcium gluconate iv

 

START salbutamol nebuliser 5mg (2.5mg if ischaemic heart disease)

 

GIVE 50ml 50% dextrose + 10iu Actrapid insulin iv over 15 mins

 

GIVE 50-100mmol sodium bicarbonate iv

 

50-100mls 8.4% over 30 mins via central line OR

 

200-400ml 2.1% over 30 mins via peripheral line

Continuing Treatment

 

DO blood gasses

 

CONSIDER repeat doses of calcium gluconate every 10-20 min

 

until ECG normal or to maximum of 50ml

 

CONSIDER 1 litre 20% glucose + 100iu Actrapid at 2ml/kg/hr

Enteral Treatment

Consider calcium resonium 30g enema, followed by 15g po TDS in water with
oral lactose 10-20ml (up to QDS)

Dialysis requirements

Persistent K+ > 7.0 mmol/L

Acidosis, pH < 7.1

Fluid Overload (pulmonary oedema)

Pericarditis

Symptomatic uraemia (urea likely >45 mmol/L

RECHECK potassium HOURLY

until < 6.0 mmol/L (unless chronic)

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