Hyperkalemia is one of the common clinical electrolyte disorders. Hyperkalemia is present in 1% to 10% of hospitalized patients.
Hyperkalemia is a common clinical emergency and sometimes insidious with a high risk of death. Intravenous calcium is the most preferred treatment for severe hyperkalemia due to its rapid onset and definite efficacy. Different calcium agents have different characteristics and applicable clinical situations. Clinically, calcium gluconate intravenous injection is recommended as a priority and should be administered in strict accordance with the dosage and speed of the instructions during the application, with close observation of ECG changes and other vital signs.
The treatment of hyperkalemia is fundamentally based on the treatment of the cause of the disease and emergency management to prevent the development and progression of fatal complications.
1. intravenous administration of calcium to antagonize the cell membrane effects of hyperkalemia
2. facilitating the transfer of potassium ions into the cells (insulin plus glucose, sodium bicarbonate application, inhaled salbutamol)
3. removal of excess potassium ions from the body (diuresis, gastrointestinal cation exchanger, blood purification)
1. Although calcium use can antagonize the effect of hyperkalemia, calcium itself or hypercalcemia can aggravate the cardiotoxic effect of digitalis. Therefore, the instructions clearly indicate that "use during the application of cardiac glycosides is prohibited". In the case of hyperkalemia due to digitalis, treatment with digoxin-specific antibody fragments (currently difficult to obtain in China) is recommended. If it is necessary, it is recommended to give it slowly and in small amounts (10-fold dilution, given over 20-30 minutes to avoid hypercalcemia) [9], and to monitor the ECG closely.
2. Rapid administration of calcium may lead to hypotension, bradycardia, and arrhythmias, so close monitoring of the ECG is necessary during administration.
3. Avoid concomitant administration of calcium gluconate with bicarbonate and ceftriaxone, or at least not by the same route, because calcium gluconate can combine with bicarbonate or ceftriaxone to become a precipitate (calcium carbonate or ceftriaxone calcium), which can be life-threatening in severe cases.
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