Hyperkalemia dextrose

Patients with acute hyperkalemia usually require other therapies to manage hyperkalemia until dialysis can be initiated. Patients who present with cardiac abnormalities caused by hyperkalemia should receive calcium gluconate or chloride (1 g intravenously) to reverse the cardiac effects. Temporary measures can be employed to shift extracellular potassium into the intracellular compartment to stabilize cellular membrane effects of excessive serum potassium levels. Such measures include the use of regular insulin (5 to 10 units intravenously) and dextrose (5% to 50% intravenously), or nebulized albuterol (10 to 20 mg). Sodium bicarbonate should not be used to shift extracellular potassium intracellularly in patients with CKD unless severe metabolic acidosis (pH less than 7.2) is present. These measures will decrease serum potassium levels within 30 to 60 minutes after treatment, but potassium must still be removed from the body. Shifting potassium to the intracellular compartment, however, decreases potassium removal by dialysis. Often, multiple dialysis sessions are required to remove potassium that is redistributed from the intracellular space back into the serum. 

Rapid correction of hyperkalemia requires administration of drugs that shift potassium intracellularly (e.g., insulin and dextrose, sodium bicarbonate, or albuterol). 

B. Hyperkalemia. Administer regular Insulin 10 U IV along with 50 mL of 50% dextrose (children 0.1 U/kg insulin with 2 mlVkg of 25% dextrose). 

RED FLAG When giving insulin for hyperkalemia, keep the patient from becoming hypoglycemic by gimng I. V. dextrose at the same time. 

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