Pediatric emergency medicine trisk 2867 2867
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Intravenous calcium to stabilize cardiac membrane
Calcium gluconate 10% solution, 50–100 mg/kg (0.5–1 mL/kg); typical
adult dose 1,000 mg, max 2,000–3,000 mg
Infuse over 2–5 min, central access is preferred, may repeat in 10 min if
needed
Patient must be on cardiac monitor
Effect is immediate in onset though transient (∼30 min)
Measures to redistribute potassium into the intracellular space
Insulin and dextrose:
Give dextrose 0.5 g/kg and provide insulin 0.1 unit/g of dextrose
Monitor blood glucose
Time to onset is ∼15–30 min, duration is 2–6 hrs
β2 -agonists:
2.5–5 mg nebulized albuterol
Time to onset is 20–30 min, duration 2–4 hrs
Sodium bicarbonate:
1–2 mEq/kg IV over 5–15 min
Minimal effect if the child is not acidemic
Time to onset ∼15–30 min, duration ∼2 hrs
Measures to remove potassium from the body
Cation exchange resins:
Sodium polystyrene sulfonate 1 g/kg orally or per rectum, may repeat
dose after 4 hrs
Do not give retention enema with sorbitol
Do not give if within 1 wk of surgery (postoperative ileus)
Time to onset is 1–2 hrs
Loop diuretics:
1–2 mg/kg furosemide IV, higher doses may be required in renal
insufficiency
To avoid hypovolemia, provide appropriate non–potassium-containing
fluids
Time to onset 15–60 min
Dialysis:
