Pediatric emergency medicine trisk 2864 2864
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effects are rarely evident at potassium concentrations less than 8 mEq/L and
include paresthesias, skeletal muscle weakness, and ascending flaccid
paralysis. Respiratory muscles are typically spared.
TABLE 100.8
MEDICATIONS ASSOCIATED WITH HYPERKALEMIA
NSAIDs
ACE inhibitors
Angiotensin II receptor blockers
Amiloride
Spironolactone
Eplerenone
Tacrolimus
Cyclosporine
Propranolol
Digitalis
Management. Treatment of hyperkalemia includes antagonizing the cell
membrane effects of hyperkalemia, shifting potassium to the intracellular
space, and removing potassium from the body ( Table 100.9 ). The urgency
of care should be based upon the degree of hyperkalemia and evidence of
cardiac or neuromuscular effects. Should there be ECG changes consistent
with hyperkalemia, the patient should be placed on cardiac monitor and IV
calcium should be provided to stabilize cardiac membranes. Calcium
administration is indicated in instances of significant ECG changes, such as
widening of the QRS or loss of the P wave, but may not be indicated with
isolated peaked T waves in the setting of mild hyperkalemia. The effect of
calcium is nearly immediate but also transient and should be coupled with
other measures to shift potassium to the intracellular space and remove
potassium from the body. Calcium gluconate (10% solution) 50 to 100
mg/kg IV or calcium chloride (10% solution) 20 mg/kg IV is infused over 2
to 5 minutes (never pushed rapidly) with continuous cardiac monitoring.
The usual adult dose of calcium gluconate is 1,000 mg and calcium chloride
is 500 to 1,000 mg. Calcium is irritating to veins and can result in tissue
