Hyperkalemia

Diagnosis

Verify Hyperkalemia.

May have:

K+>6

ECG changes:

Tall peaked T waves
Prolonged PR
Wide QRS
Heart block
Sine wave
V fib or asystole

Causes of Hyperkalemia:

Excessive intake: massive or “old” blood products, TPN, cardioplegia, KCl infusion
Shift of K+ from tissues to plasma: crush injury, burns, succinylcholine, malignant hyperthermia, acidosis
Inadequate excretion: renal failure
Pseudohyperkalemia: hemolyzed sample, thrombocytosis, leukocytosis

If hemodynamically unstable, start CPR/PALS while continuing to treat
Hyperventilate with 100% O₂
Give calcium gluconate 60-100 mg/kg IV or calcium chloride 20 mg/kg IV
Give calcium gluconate
mg
(60-100 mg/kg)
IV or calcium chloride
mg
(20 mg/kg)
IV
If peripheral IV, visually confirm no infiltration while injecting
- 20 mg/kg IV
- 60-100 mg/kg IV
Flush tubing after calcium administration
Stop K+ containing fluids (LR/RBC); switch to NS
Dextrose 0.5-1 g/kg IV (MAX 50 g) and insulin 0.1 Unit/kg IV (MAX 10 units)
Albuterol puffs or nebulized, once cardiac rhythm stable
Sodium bicarbonate 1-2 mEq/kg IV
Furosemide 0.5-1 mg/kg IV
If CARDIAC ARREST > 6 min, activate ECMO
Dialysis if refractory to treatment
If transfusion required, use washed or fresh RBCs
Consider DDx
- 1-2 mEq/kg IV
- 4-10 puffs through ETT or nebulized
- 0.5-1 g/kg IV, MAX 50 g
- 0.1 Units/kg IV, MAX 10 Units
- 0.5-1 mg/kg IV
Crisis Management (If Severe)
Notify surgeon, call for help and code cart
Call for Transesophageal Echocardiography
Start chest compressions
Give epinephrine 10 MICROgrams/kg IV/IO
If cardiac arrest, go to CARDIAC ARREST
Consider ECMO

Diagnosis

Verify Hyperkalemia.

May have:

K+>6

ECG changes:

Tall peaked T waves
Prolonged PR
Wide QRS
Heart block
Sine wave
V fib or asystole

Causes of Hyperkalemia:

Excessive intake: massive or “old” blood products, TPN, cardioplegia, KCl infusion
Shift of K+ from tissues to plasma: crush injury, burns, succinylcholine, malignant hyperthermia, acidosis
Inadequate excretion: renal failure
Pseudohyperkalemia: hemolyzed sample, thrombocytosis, leukocytosis

If hemodynamically unstable, start CPR/PALS while continuing to treat
Hyperventilate with 100% O₂
Give calcium gluconate 60-100 mg/kg IV or calcium chloride 20 mg/kg IV
Give calcium gluconate
mg
(60-100 mg/kg)
IV or calcium chloride
mg
(20 mg/kg)
IV
If peripheral IV, visually confirm no infiltration while injecting
Flush tubing after calcium administration
Stop K+ containing fluids (LR/RBC); switch to NS
Dextrose 0.5-1 g/kg IV (MAX 50 g) and insulin 0.1 Unit/kg IV (MAX 10 units)
Albuterol puffs or nebulized, once cardiac rhythm stable
Sodium bicarbonate 1-2 mEq/kg IV
Furosemide 0.5-1 mg/kg IV
If CARDIAC ARREST > 6 min, activate ECMO
Dialysis if refractory to treatment
If transfusion required, use washed or fresh RBCs
Consider DDx
Crisis Management (If Severe)
Notify surgeon, call for help and code cart
Call for Transesophageal Echocardiography
Start chest compressions
Give epinephrine 10 MICROgrams/kg IV/IO
If cardiac arrest, go to CARDIAC ARREST
Consider ECMO

Drugs

Calcium chloride	20 mg/kg IV
Calcium gluconate	60-100 mg/kg IV
Sodium bicarbonate	1-2 mEq/kg IV
Albuterol	4-10 puffs through ETT or nebulized
Dextrose	0.5-1 g/kg IV, MAX 50 g
Insulin	0.1 Units/kg IV, MAX 10 Units
Furosemide	0.5-1 mg/kg IV

Differential (Partial)

Fat, thrombotic, cement embolus, AIR EMBOLISM
ANAPHYLAXIS
LOCAL ANESTHETIC Systemic TOXICITY