Continuous infusion of a standard combination solution in the management of hyperkalemia

Abstract

Hyperkalemia, due to its effect on cardiac conductivity, is a potentially life-threatening electrolyte abnormality. Multiple therapeutic agents may be used alone or in combination for its prompt management. We report on the safety and efficacy of continuous infusion of a solution containing fixed concentrations of calcium gluconate, insulin, dextrose and sodium acetate (HyperK-Cocktail) for the treatment of hyperkalemia. This solution is prepared at our institution and is infused parenterally until the plasma potassium level stabilizes. Twenty-one consecutive hyperkalemic patients managed with HyperK-Cocktail on 23 occasions are reported. None of the subjects had intravenous extravasation injuries, hypernatremia, hypocalcemia, hypercalcemia or alkalosis during HyperK-Cocktail infusion. Transient hyperglycemia developed in nine subjects and hypoglycemia in one subject. The decrease in serum potassium was similar in the initial hour when compared to prior studies using a beta-agonist and/or insulin and glucose; a larger decrease was present from 2 to 8 h with the HyperK-Cocktail. The plasma potassium decreased by a mean of 1.0, 1.7, 2.1 and 2.1 mmol/L at 1, 2, 4 and 8 h, respectively. The mean serum potassium at hours 1-8 was significantly lower than the initial level. The results of our study demonstrated that HyperK-Cocktail is a safe and effective combination therapy for children with hyperkalemia.