- Patient that are suspected to have, or are at risk of renal failure (such as dialysis patients or crush injury) should have an EKG performed. Hyperkalemia should be suspected if the patient exhibits a wide QRS (> 0.12 sec) or peaked T-waves.
- If the patient with suspected hyperkalemia is hypotensive, has altered mental status or experiences cardiac arrest, give the following medications in this order:
- Calcium chloride 1 g SLOW IV/IO push
- Albuterol 5 mg nebs back-to-back/continuously for the spontaneously breathing patient or in-line with BVM if an advanced airway has been placed, and
- If no change in patient condition, consider Sodium Bicarbonate, 100 mEq IV/IO push. Sodium bicarbonate may form a solid with calcium chloride – ensure line is properly flushed before administration.
Note: It is acceptable to use Lactated Ringers in patients with Hyperkalemia