From the Guidelines
A person with hyperkalemia can typically receive 1-2 doses of calcium gluconate (10 mL of 10% solution) administered intravenously over 2-3 minutes, with a second dose given after 5-10 minutes if ECG abnormalities persist. This recommendation is based on the most recent and highest quality study available, which emphasizes the importance of prompt treatment for acute hyperkalemia to prevent cardiac arrhythmias and other complications 1. The use of calcium gluconate in this context is supported by its ability to rapidly reduce the membrane excitatory effects of potassium on cardiac tissue, thereby minimizing the potential for cardiac arrhythmia.
Key Considerations
- The maximum recommended amount of calcium gluconate is generally 30 mL of 10% solution in a 24-hour period.
- Calcium gluconate does not lower serum potassium levels but protects the heart from the effects of hyperkalemia for approximately 30-60 minutes.
- Administration should be done with cardiac monitoring, and caution is needed in patients taking digoxin as calcium can potentiate digoxin toxicity.
- If hyperkalemia is severe or persistent, additional treatments such as insulin with glucose, beta-agonists, or dialysis will be needed to actually reduce potassium levels.
Treatment Approach
- Intravenous calcium gluconate administration is a temporary measure to stabilize cardiac cell membranes and reduce the risk of arrhythmias.
- Other treatment options for acute hyperkalemia include insulin/glucose, inhaled β-agonists, intravenous sodium bicarbonate, and hemodialysis.
- The choice of treatment depends on the magnitude or severity of the increase in potassium concentration, especially when combined with marked electrocardiographic (ECG) changes and severe muscle weakness 1.
From the Research
Calcium Glucose Dosing for Hyperkalemia
- The dosing of calcium glucose for hyperkalemia is not explicitly stated in terms of the number of doses a person can receive, but rather as a treatment approach to stabilize cardiac membranes 2, 3.
- Calcium gluconate 10% is recommended to be dosed 10 mL intravenously for membrane stabilization, unless the patient is in cardiac arrest, in which case 10 mL calcium chloride is warranted 2.
- The effectiveness of IV Calcium gluconate in treating hyperkalemia has been studied, with results showing it to be effective in main rhythm ECG disorders due to hyperkalemia, but not in nonrhythm ECG disorders 4.
- A systematic review and meta-analysis found no evidence to support a clinical beneficial effect of calcium for the treatment of hyperkalemia 5.
- Insulin and glucose are frequently used to manage patients with hyperkalemia, with recommendations to reduce the risk of hypoglycemia, such as using lower doses of insulin and administering dextrose as a prolonged infusion 6.
Treatment Approaches
- Treatment of hyperkalemia includes measures to stabilize cardiac membranes, shift potassium from extracellular to intracellular stores, and promote potassium excretion 2, 3.
- Other treatment approaches include the use of beta-agonists, intravenous insulin, and dialysis 2, 3.
- The choice of treatment depends on the severity of the hyperkalemia and the presence of EKG changes or other symptoms 2, 3.