repeated after 5-10 min if no change in electrocardiogram (ECG) occurs


10-20 units of regular insulin IV


Lowers serum potassium by enabling more potassium to enter the cell


25-50 g IV


Protects the patient from a hypoglycemic reaction

Sodium polystyrene sulfonate (Kayex-alate)

Orally or by enema: 15 g/60 mL in 20-100 mL sorbitol to facilitate passage of resin through intestinal tract

Cation exchange resin: 0.5-1.0 mEq/L of potassium is removed with each enema, but an equivalent amount of sodium is retained

Exchanges sodium for potassium in the gastrointestinal (GI) tract, leading to the elimination of potassium

Other: As an emergency measure, sodium bicarbonate delivered IV (one ampule of a 7.5% NaHCO3 solution) increases pH and causes potassium to shift into the cells; it is particularly effective in treating metabolic acidosis. Note that pseudohyperkalcemia (false elevation of potassium) may occur from improper blood drawing technique with hemolysis, laboratory error, leukocytosis, and thromobocytosis.


Provide clear explanations and allow the patient to express concerns throughout the treatment course. Involve family members and the support system in teaching. Patients who are experiencing hyperkalemia should avoid foods high in potassium. These include potatoes, beet greens, bananas, orange juice, dried fruit, coffee, tea, and chocolate. Draw blood samples to ensure accurate potassium-level measurement. Do not draw a sample from above an IV site where potassium is infusing, make certain the sample gets to the lab quickly, do not leave a tourniquet on for prolonged periods, and do not have the patient repeatedly clench and relax her or his fist.

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