Calcium gluconate 10%membrane stabiliser
Dose10–30 mL of 10% IV over 2–5 min for hyperK ECG changes; repeat q10 min ×3 PRN
Preparation10 mL ampoules (2.2 mmol Ca²⁺ each), undiluted slow push with cardiac monitor
MonitorECG immediately (QRS narrows); effect 1–3 min, lasts 30–60 min — shift/remove K⁺ in parallel
Insulin + dextrose (hyperK)K⁺ shift therapy
Dose10 units regular insulin IV + 25 g dextrose (50 mL of 50%), onset 15–30 min, lasts 4–6 h
Preparation50 mL 50% dextrose push + 10 U insulin; if glucose >14, give insulin alone; add 10% dextrose infusion if needed
MonitorCapillary glucose q15–30 min ×2 h (hypoglycaemia), K⁺ at 1–2 h
Salbutamol (albuterol)SABA
DoseHyperkalemia: 10–20 mg nebulized over 10 min (adjunct to insulin; onset ~30 min, lowers K ~0.5–1 mmol/L). Asthma: 2.5–5 mg q15–20 min ×3 then q1–4h
Preparation2.5/5 mg nebules + O₂-driven nebuliser at 6–8 L/min
MonitorHR, tremor, K⁺ (shifts intracellularly — used in hyperK), SpO₂
Sodium bicarbonate 8.4%alkalising agent
DoseTCA: 1–2 mmol/kg IV bolus then infusion to pH 7.50–7.55. Salicylate: urine alkalinisation pH 7.5–8.5
PreparationBolus 50–100 mL of 8.4% (1 mmol/mL); infusion 150 mmol in 1 L D5W + 20–40 mmol KCl
MonitorABG, K⁺ (hypokalaemia blocks alkalinisation), ionised Ca²⁺, volume
Furosemide IVloop diuretic
Dose40–80 mg IV slow push; infusion 5–40 mg/h in refractory congestion
Preparation20 mg/2 mL ampoule undiluted over 2–5 min (ototoxic if fast); infusion 250 mg in 50 mL NS via pump
MonitorUrine output, K⁺, Mg²⁺, creatinine, volume status