ER Protocols

Hyperkalemia

C BIG K DROP

C alcium gluconate 10%
B icarb- sodiu bicarbonate 8.4% (50 mEq) over 5m or Beta agonist- Salbutamol nebulized
I nsulin- lispro IV
G lucose- D50W 1 ampoule
K ayexalate
D iuretics- furosemide 40-80mg
ROP- renal dialysis of patient

Calcium is a cardiac stabilizer
Bicarb/Beta agonist causes temporary intracellular shift
Insulin causes temporary intracellular shift and glucose maintains blood glucose
Kayexalate facilitates GI potassium removal
Diuretics facilitate renal removal
Renal dialysis provides extracorporeal removal