Table 2.

Treatment of hyperkalemia

Mechanism of action	Therapy	Dose and administration	Onset/duration
I. Membrane stabilization (cardiac injury)	Calcium: calcium gluconate 10 %	10 ml iv in 2–5 min	5–10 min/30–60 min
II. Shift of potassium intracellularly	Insulin + glucose	10U regular insulin iv + 50 g of glucose (500 ml 10 % or 50 ml 50 % (Glucosmon®) iv	15–30 min/6–8 h
	β2-adrenergic agonist: salbutamol	0.5 mg 100 ml glucose 5 % in 15 min iv 10–20 mg (2–4 ml) nebulized in 10 min	5–8 min/2–3 h
	Sodium bicarbonate (especially in acidemia)	Bicarbonate 1/6 M, 250–500 ml or 50 ml 1 M iv	30–60 min/6–8 h
II. Removal of potassium	Chelating agents: sodium or calcium polystyrene sulfone	Oral:15–50 g/4–6 h (3–6 spoons with water)	1 h/4–6 h
		Enema: 30–100 g/4–6 h (dissolved in 250 ml)	1 h/12 h
	Loop diuretic: furosemide, torasemide	40–200 mg iv 10–100 mg iv with control of renal function	30 min/8 h
	Dialysis	2–3 h	Immediate/duration of dialysis