From the Guidelines
For hyperkalemia, the recommended calcium dose is 10 mL of 10% calcium gluconate (containing 1 gram or 4.65 mEq of calcium) administered intravenously over 2-3 minutes, as supported by the most recent and highest quality study 1. This can be repeated after 5 minutes if ECG changes persist. Alternatively, 5-10 mL of 10% calcium chloride (containing 13.6 mEq of calcium) can be used, but it should be administered through a central line due to its potential to cause tissue damage if extravasation occurs.
Key Considerations
- Calcium does not lower serum potassium levels but rather antagonizes the cardiac membrane effects of hyperkalemia, providing temporary protection against arrhythmias, as noted in 1 and 2.
- This cardiac membrane stabilization effect begins within minutes but only lasts 30-60 minutes, so definitive treatment to remove excess potassium must follow promptly.
- Calcium should be administered with caution in patients taking digoxin as it may potentiate digoxin toxicity.
- Always monitor the ECG during administration, and ensure the patient is on continuous cardiac monitoring throughout treatment for hyperkalemia.
Treatment Overview
- Treatment options for acute hyperkalemia include intravenous calcium gluconate, insulin/glucose, inhaled β-agonists, intravenous sodium bicarbonate, and hemodialysis, as outlined in 1.
- The choice of treatment depends on the severity of hyperkalemia, ECG changes, and the patient's underlying medical conditions.
- It is essential to follow a standardized treatment protocol, such as the one suggested in 1, to ensure optimal management of hyperkalemia.
From the Research
Calcium Dose for Treating Hyperkalemia
- The recommended calcium dose for treating hyperkalemia is calcium gluconate 10% dosed 10 mL intravenously, unless the patient is in cardiac arrest, in which case 10 mL calcium chloride is warranted 3.
- Calcium gluconate is used to stabilize cardiomyocyte membranes, and its effectiveness in treating hyperkalemia has been evaluated in several studies 4, 5.
- The use of calcium gluconate in hyperkalemia treatment is supported by studies that show its ability to improve main rhythm disorders due to hyperkalemia, although its effectiveness in nonrhythm ECG disorders is limited 5.
- Other treatments for hyperkalemia include insulin and glucose administration, beta-2 agonists, and dialysis, which can help lower potassium levels and prevent cardiac complications 3, 4, 6, 7.
Key Considerations
- Hyperkalemia is a life-threatening condition that requires prompt recognition and treatment to prevent cardiac complications 3, 4, 6, 7.
- The treatment of hyperkalemia involves a combination of measures to stabilize cardiac membranes, shift potassium into cells, and promote potassium excretion 3, 4, 7.
- Calcium gluconate is an important part of hyperkalemia treatment, but its use should be guided by the patient's clinical condition and electrocardiogram (ECG) findings 3, 5.