Veterinary Anesthesia & Analgesia Support Group
Practical Information for the Compassionate Veterinary Practitioner
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  Hyperkalemia Management Basics
  Bob Stein
  December, 2004


a)      General Information

i)        Serum potassium levels are most likely to create electrocardiographic changes when levels reach or exceed 8 mml/L

(1)   Consequences include ventricular fibrillation and atrial standstill

b)      Corrective options

i)        Calcium gluconate or calcium chloride - 10% solution

(1)   Calcium Gluconate - 0.5 to 1.0 ml/kg slowly IV

(2)   Calcium Chloride – 0.5 ml/kg slowly IV

(3)   Duration of effect ~ 20 to 30 minutes

(4)   Does not lower serum potassium but helps normalize cell membrane potentials

ii)       Dextrose-insulin infusion

(1)   0.25 to 1.0 U/kg regular insulin with 2 grams of dextrose per unit of insulin

(a)    Use the low end of the insulin dose range for cats

(2)   Decreases serum potassium within 5 minutes

(3)   Duration of effect ~ 20 to 45 minutes

iii)     Sodium bicarbonate

(1)   0.5 to 2 mEq/kg IV

(2)   Ideally, bicarbonate administration should be based upon patient blood gas analysis

(a)    When unavailable, bicarbonate may be given if patient is unlikely to have pre-existing metabolic alkilosis

iv)     Follow all treatment sequences with a fluid diuresis

(1)   0.9% saline may be the best initial choice

(2)   Balanced electrolyte solutions are also an adequate option

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