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Treatment algorithm for elevated potassium levels
Severe hyperkalemia can cause fatal arrhythmias. This calculator is for MEDICAL PROFESSIONALS only. Obtain immediate EKG. Continuous cardiac monitoring required. STAT treatment if EKG changes present. Consider emergent dialysis if K+ >7 or refractory.
Peaked T waves, wide QRS, loss of P waves, or other conduction changes
| K+ Level | EKG Changes | Treatment |
|---|---|---|
| <5.5 mEq/L | None | Address cause. Consider K+ binders if chronic. Monitor. |
| 5.5-6.0 mEq/L | None | Shift (insulin+dextrose, albuterol). K+ binders. |
| 6.0-6.5 mEq/L | None | Shift + K+ removal. Consider calcium if high-risk. |
| 6.0-6.5 mEq/L | Present | Calcium (STAT) + Shift + Removal. Cardiac monitor. |
| >6.5 mEq/L | Any | Calcium (STAT) + Shift + Removal. Consider dialysis. |
| >7.0 mEq/L | Often present | EMERGENCY. All treatments + emergent dialysis. |
Give calcium immediately if ANY EKG changes are present OR if K+ >6.5 mEq/L. Calcium stabilizes cardiac membrane and prevents arrhythmias but doesn't lower potassium. It buys time for other treatments to work.
Insulin drives K+ into cells but also causes hypoglycemia. Give 25g dextrose (1 amp D50) with 10 units regular insulin. Check glucose q1hr × 6 hours as hypoglycemia can occur hours later.
Calcium: 0 (cardioprotective only). Insulin+D50: 0.5-1.2 mEq/L. Albuterol: 0.5-1.0 mEq/L. Kayexalate: 0.5-1.0 mEq/L per dose. Dialysis: 1-2 mEq/L per hour. Effects are additive - use multiple therapies.
Only effective if metabolic acidosis is present (pH <7.2). Correcting acidosis shifts K+ back into cells. Give 150 mEq (3 amps) in 1L D5W over 2-4 hours. Not effective as monotherapy.
Yes - risk of intestinal necrosis, especially with sorbitol. Avoid in post-op patients or those with ileus. Newer K+ binders (patiromer, sodium zirconium) are safer. Use diuretics if patient makes urine.
Falsely elevated K+ from hemolysis during blood draw (most common), thrombocytosis, or leukocytosis. If K+ is high but patient has NO EKG changes and NO symptoms, repeat labs before aggressive treatment. True hyperkalemia always causes EKG changes at K+ >6.5.