Expansion
Stabilise the membrane, shift potassium into cells, then remove it from the body
Expansion
1. Stabilise the myocardium
- Calcium gluconate or chloride
- Raises the threshold potential, restoring the gap between resting and threshold
- Works within minutes, lasts 30 to 60 minutes, and does not change the potassium level
2. Shift potassium into cells
- Insulin with dextrose: stimulates the sodium-potassium ATPase; the most reliable, acting within 15 minutes
- Salbutamol nebulised: beta-2 stimulation, additive with insulin
- Sodium bicarbonate: only useful in significant acidosis
3. Remove potassium from the body
- Dialysis, the definitive method
- Potassium binders such as patiromer or sodium zirconium cyclosilicate
- Loop diuretics if renal function permits
Steps 1 and 2 buy time; only step 3 treats the problem, so the potassium will rebound if removal is not arranged.
Always stop contributing drugs: ACE inhibitors, angiotensin receptor blockers, spironolactone, trimethoprim and NSAIDs.