From the Guidelines
A repeat dose of calcium gluconate is necessary if the patient's potassium level remains above 6 mEq/L after the initial dose, as it helps to stabilize cardiac cell membranes and prevent arrhythmias. The management of acute hyperkalemia involves several treatment options, including intravenous calcium gluconate, insulin/glucose, inhaled β-agonists, intravenous sodium bicarbonate, and hemodialysis 1. Intravenous calcium gluconate administration rapidly reduces the membrane excitatory effects of potassium on cardiac tissue within 1 to 3 minutes, thereby minimizing the potential for cardiac arrhythmia, but only minimally reduces serum potassium concentrations 1. If no effect is observed within 5 to 10 minutes, another dose of calcium gluconate may be given 1. Some key points to consider when administering calcium gluconate include:
- The standard dose is 1-2 grams of calcium gluconate (10-20 mL of 10% solution) administered intravenously over 2-5 minutes 1
- Calcium does not lower potassium levels but temporarily stabilizes cardiac cell membranes, protecting against arrhythmias for approximately 30-60 minutes
- Cardiac monitoring is essential when administering repeat doses, and caution should be exercised in patients taking digoxin as calcium can potentiate digoxin toxicity
- Definitive treatment to remove excess potassium from the body (such as diuretics, potassium binders, or dialysis) should be initiated concurrently 1.
From the Research
Hyperkalemia Treatment
The treatment of hyperkalemia involves several steps, including membrane stabilization, cellular shift, and excretion of potassium.
- According to 2, calcium gluconate 10% dosed 10 mL intravenously should be provided for membrane stabilization, unless the patient is in cardiac arrest.
- However, 3 states that there is no evidence to support a clinical beneficial effect of calcium for treatment of hyperkalemia.
Repeat Dose of Calcium Gluconate
If a patient has already received 1 dose of calcium gluconate for hyperkalemia and their repeat potassium is still above 6, the decision to administer a repeat dose should be based on the patient's clinical condition and EKG changes.
- 4 suggests that the initiation of short-term measures can be launched by either a single or combined regimen of the three agents that cause a transcellular shift of potassium - insulin with glucose, beta(2)-agonist (albuterol), and NaHCO(3).
- The use of calcium gluconate may not be necessary if the patient's potassium level is not decreasing, and other treatment options such as insulin and glucose, or beta-agonists can be considered.
Treatment Options
Other treatment options for hyperkalemia include:
- Insulin with glucose: 4 and 3 suggest that insulin with glucose can be effective in reducing potassium levels.
- Beta-agonists: 4 and 3 suggest that beta-agonists such as albuterol can be effective in reducing potassium levels.
- Diuretics: 4 suggests that diuretics such as furosemide can be used to remove potassium from the body.
- Dialysis: 2 and 4 suggest that dialysis is the most efficient means to enable removal of excess potassium.