You are called to assess a 45 year old male with diabetes and chronic kidney disease from diabetic nephropathy. He has been admitted to the hospital with a diagnosis of pneumonia. You are told he has:
Serum K = 6.9 mmol/L
HCO3 = 24
Cr = 180 micromol/L
Write your orders for the initial management of this patient’s hyperkalemia. Include doses where indicated.
Typical orders would include:
- Establish IV access.
- Stat ECG
- IV calcium gluconate (if not taking digoxin)
- IV Humulin R 10-20 units X 1 dose
- IV D50W 1 AMP X 1 dose
- Blood sugar with bedside glucometer hourly
- Calcium resonium 30 gram in 50 cc of 70% sorbitol (if nocontraindication)
For a more detailed review on hyperkalemia, try the following links:
Palmer, Biff F. Managing Hyperkalemia Caused by Inhibitors of the Renin-Angiotensin-Aldosterone System. N Engl J Med 2004 351: 585-592 (PubMed)