- Hyperkalemia is one of the reversible causes of refractory cardiac arrest covered in the H's and T's. It is common in patients with kidney disease, and would probably be an initial consideration in a dialysis patient's refractory cardiac arrest or PEA. Those with a truly excessive amount of dietary potassium are also at risk. The severity of hyperkalemia not only depends on the total serum potassium level, but on how rapidly the level has risen (in other words, has the body had time to adjust?)
Remember- hyperkalemia is considered a REVERSIBLE cause of arrest, and there are a few things that can be done to drive the potassium into tissue cells (and, therefore out of the bloodstream) and assist this patient if high serum potassium levels are considered a primary factor.
- Calcium IV can be given to strengthen muscular contraction, and override some of the symptoms of hyperkalemia. This is probably the best initial response when hyperkalemia is considered to be a contributing factor to refractory arrest.
Sodium Bicarbonate can also be considered, as acidosis is a primary contributor of hyperkalemia.
A glucose and insulin infusion can be helpful in this case, as it can drive potassium into the cells.
Albuterol by nebulization can also drive potassium into cells.
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