A girl aged 8 years has been admitted for dialysis. Her serum potassium level is 7.5 meq/1, which of the following treatment modality is the fastest way to reduce her hyperkalemia?
Rapid way of reducing serum potassium is by intravenous administration of insulin which acts by redistributing glucose into cells. The recommended dose is 10 units of IV regular insulin followed immediately by 50 mL of 50% dextrose. Other treatment modalities include: ? Intravenous calcium gluconate or chloride: it is given to antagonize the effect of increased level of potassium on hea. It acts by raising the action potential threshold and by reducing the excitability without changing the resting membrane potential. ? Beta 2 agonists (albuterol) is used for the acute management of hyperkalemia. It should be used with caution in hyperkalemic patients with known cardiac disease. ? Intravenous bicarbonate is reserved for patients with hyperkalemia and concomitant metabolic acidosis. ? Removal of potassium is done using cation exchange resins(sodium polystyrene sulfonate), diuretics, and/or dialysis. Ref: Harrison's Internal Medicine, 18th Edition, Chapter 45
IV NaHC03
Kayexalate enema
IV Calcium gluconate
Infusion of insulin + glucose