Severe hyperkalemia should take urgent measures, treatment for hyperkalemia is based on the different severity of the disease.
1. The treatment of acute hyperkalemia principles:
10% of intravenous calcium gluconate 10ml, in 5 ~ 10min after injection, rapid elimination of ventricular arrhythmias. Due to the role of calcium to maintain a short time, followed by continuous infusion should be. In 500ml normal saline or 5% glucose solution 10% add 20 ~ 40ml of calcium gluconate infusion.
Treatment to reduce serum potassium Methods: Plasma and extracellular potassium into cells temporarily. Can be intravenous hypertonic glucose and insulin infusion, 25% ~ 50% glucose solution 60 ~ 100ml, each add 2 ~ 3g sugar insulin (insulin) 1U intravenous injection, followed by intravenous infusion of 10% glucose solution 500ml, add with insulin ( insulin) 15U. In case of heart failure or kidney patients, the rate should be slow infusion; If you want to limit the entry of water, glucose concentration can be increased to 25% ~ 50%. At the close monitoring of the process of infusion changes in serum potassium and low blood sugar reaction. Intravenous injection can also be re-five percent sodium bicarbonate solution, followed by 5% sodium bicarbonate intravenous infusion of 150 ~ 250ml. This method of metabolic acidosis there is a more appropriate patients. Extracellular potassium can bring into the cells, but also to correct metabolic acidosis. It should be noted that sodium bicarbonate can not be combined with calcium gluconate, calcium carbonate precipitation will produce shared. Of life-sustaining dialysis with end stage renal failure patients are not ideal results. End-stage renal failure patients on hemodialysis can be used to remove the body of potassium.
2. The treatment of mild hyperkalemia:
1) low potassium diet, daily intake of potassium-limited to 50 ~ 60mmol (50 ~ 60mEq).
2) stop the drug which may cause potassium increased.
3) cation exchange resin to reduce the intestinal absorption of potassium and potassium from the body, 1mEq exchangeable sodium potassium 1mEq. Vinyl resins such as kayexelate or sodium polystyrene may be oral, or retention enema, but the effect of oral better than the enema. Oral dose of 40 ~ 80g, points 3 to 4 times suits, 20% sorbitol at the same time serving 10 ~ 20ml. Enema 40g resin can be placed in 200ml 20% sorbitol as retention enema solution, a solution to retain stool after 1h.
3. Hemodialysis. For the fastest and most effective way. Available peritoneal dialysis or hemodialysis, but the latter effects are relatively frequent, and slower effect. Application of low potassium or potassium dialysate for hemodialysis, serum potassium can begin almost immediately after dialysis decreased, 1 ~ 2h after the potassium can be restored to almost normal. Peritoneal dialysis application of common standards for the exchange of dialysis fluid per hour at 2L circumstances, 5mmol around the exchangeable potassium, dialysis for 36 ~ 48h to remove 180 ~ 240mmol potassium.