An explosion casualty suffering from crush injuries of the lower extremities has been admitted to your hospital with severe hyperkalemia What emergency treatment is recommended?

Answer 1

Limit mannitol, administer glucose-insulin drip, calcium chloride and/or sodium bicarbonate

DO NOT LIMIT LIQUIDS!

Treatment of hyperkalemia may include any of the following measures, either singly or in combination:

• A diet low in potassium (for mild cases).
• Discontinue medications that increase blood potassium levels.
• Intravenous administration of glucose and insulin, which promotes movement of potassium from the extracellular space back into the cells.
• Intravenous calcium to temporarily protect the heart and muscles from the effects of hyperkalemia.
• Sodium bicarbonate administration to counteract acidosis and to promote movement of potassium from the extracellular space back into the cells.
• Diuretic administration to decrease the total potassium stores through increasing potassium excretion in the urine. It is important to note that most diuretics increase kidney excretion of potassium. Only the potassium-sparing diuretics mentioned above decrease kidney excretion of potassium.
• Medications that stimulate beta-2 adrenergic receptors, such as albuterol and epinephrine, have also been used to drive potassium back into cells.
• Medications known as cation-exchange resins, which bind potassium and lead to its excretion via the gastrointestinal tract.
• Dialysis, particularly if other measures have failed or if renal failure is present.