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6 out of 9

Hyperkalemia without ECG changes. All used in t/t EXCEPT: (AIIMS Nov 2009)

A Insulin-Glucose

B Calcium Gluconate

C Soda Bicarbonate

D Salbutamol

Ans. C

Soda Bicarbonate

Hyperkalemia is treated by following ways. (Ref-.Harrison 18th e/p. 358.)

1. Injection calcium gluconate – It stabilizes cardiac membrane and thus prevent arrhythmia. It does not reduce serum potassium level. It is usually given when serum potassium level are very high.

2. Injection dextrose insulin drip – It is the most widely used method to reduce serum potassium level. It is the fastest method to reduce potassium level.

3. Beta 2 agonist – Like salbutamol & Albuterol can also reduce serum potassium level.

4. Potassium chelating resin – They are used orally, usually for long term use, they prevent serum potassium level to rise. Resins are slow acting used in chronic hyper kalemia

5. Dialysis

6. Injection NaHCO3 – It is used to treat severe acidosis when PH is below 7.1. Acidosis is usually associated with hyperkalemia so when we treat by NaHCO3, potassium level also falls. But please note NaHCO3 is not used to treat hyperkalemia as such!!!

Treatment for urgent control of hyperkalemia.

Modality Onset Duration

Calcium Gluconate 0-5 minutes 1 hour

Insulin 15-60 minutes 4-6 hours

Albuterol 15-30 minutes 2-4 hours

Extra Edge: (Hari-18th Pg 359)

Intravenous bicarbonate has no role in the routine treatment of hyperkalemia. It should be reserved for patients with hyperkalemia and concomitant metabolic acidosis, and only if judged appropriate for management of the acidosis.