Treatment of hyperkalemia in children

Agent	Dose	Onset of action
Stabilization of cardiac myocardial membrane in setting of hyperkalemia-associated abnormal ECG or arrhythmia*
Calcium gluconate, 10 percent^¶	0.5 to 1 mL/kg IV over 5 to 15 min (50 to 100 mg/kg calcium gluconate, maxiumum dose 3 grams) Repeat after 10 minutes, if needed	Immediate
Movement of extracellular potassium into the cells*
Glucose and insulin	IV administration of glucose 0.5 g/kg (equal to 2 mL/kg of a 25 percent dextrose solution) IV administration of insulin 0.1 units/kg over 30 min	30 minutes
Inhaled beta-agonists (albuterol)	0.1 to 0.3 mg/kg	30 minutes
Sodium bicarbonate^Δ	IV administration of 1 mEq/kg over 10 min (maximum dose of 50 mEq per hour)	15 minutes
Removal of potassium
Sodium polystyrene sulfonate	1 g/kg PO or PR with sorbitol	1 to 2 hours
Furosemide	IV administration of 1 to 2 mg/kg with replacement of fluid loss	1 to 2 hours
Hemodialysis

IV: intravenous administration; PO: oral administration; PR: rectal administration; ECG: electrocardiogram.
* These measures do not remove potassium and additional interventions may be required to lower overall potassium levels.
¶ Calcium should be administered in a larger vein or central line preferably (irritant), and sodium bicarbonate should not be introduced into the line because of potential precipitation. Continuous ECG monitoring should be performed during administration.
Δ Administration of sodium bicarbonate may have a minimal effect.

Graphic 82874 Version 3.0

خرید پکیج

Treatment of hyperkalemia in children