1. What are the EKG manifestations associated with hyperkalemia? Do these changes occur in a particular order?
2. What is the role of Kayexalate in the treatment of hyperkalemia?
3. Is there a threshold serum potassium level or particular EKG finding that triggers you to administer calcium? How do you give calcium when you use it?
4. When do you re-dose patients you’ve treated for hyperkalemia?
Some of my colleagues routinely give IV CaGluconate for significant hyperkalemia, even in the absence of arrhythmias. Is this necessary or wise?
Dr. Mitchiner: thank you for your question and your reading of the site. The question of when to give calcium (gluconate or chloride) is #3 on our hyperkalemia questions for this month, the “answers” to which are to be published shortly. In brief, there doesn’t appear to a set guideline or evidence basis for giving calcium based on severity of hyperkalemia, although consensus and “expert” recommendation typically includes severity as a reason to give it. This appears to be even in the absence of EKG changes, for the sake of stabilizing cardiac myocytes that have not yet evidenced a clinical change but may do so soon.