Patients with suspected or known hyperkalemia need intravenous access, cardiac monitoring, and fluid resuscitation. Treatment should be initiated based upon the patient’s symptomatology, ECG findings, and laboratory values. However, the absolute potassium value for treatment should be seen as arbitrary, and used in conjunction with the emergency clinician’s clinical judgment. The overall goal for the treatment of hyperkalemia should be to stabilize the cardiac membrane to prevent life-threatening dysrhythmias, to shift potassium from the extracellular space into the cell, to enhance elimination, and to treat the underlying cause of hyperkalemia. A Cochrane review of the literature from 2005, updated in 2009, does not make specific recommendations for the level to begin treatment, but does note that beta agonists, insulin and glucose, and dialysis are all acceptable means of treatment for acute hyperkalemia.48 (See Table 6.)
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