Hyperkalemia clinical presentation

The AASLD practice guidelines recommend that diuretic therapy be initiated with the combination of spironolactone and furosemide. Spironolactone alone was commonly recommended for initial therapy, but clinical trials have demonstrated a 14-day delay in the onset of action, as well as the development hyperkalemia when spironolactone is used alone. Administering spironolactone in single daily doses is justified based on its pharmacokinetics and helps to improve patient compliance. If tense ascites is present, paracentesis... 

B. Specific drugs and antidotes. When clinically significant hypocalcemia is present, administer intravenous calcium gluconate (see p 424), 10-20 mL (children 0.2-0.3 mL/kg), and monitor ionized calcium levels and titrate further doses as needed. Treat hypomagnesemia with intravenous magnesium sulfate, 1-2 g given over 10-15 min (children 25-50 mg/kg diluted to less than 10 mg/mL). Treat hyperkalemia with intravenous calcium and other usual measures (p 37). 

---