Hyperkalemia: STABILIZE, SHIFT, SEND-IT (I C BIG K DROP)

Hyperkalemia: STABILIZE, SHIFT, SEND-IT (I C BIG K DROP)



The 3-Step Approach to Acute Hyperkalemia

1. Stabilize: the Heart (If ECG changes) → Calcium

2. Shift: K+ Into Cells → Insulin + Glucose, Albuterol, Bicarb (if acidotic)

3. Send-it: Remove K+ From Body → Diuretics (if making urine), Kayexalate (if GI motility intact), Dialysis (if severe/refractory)


I – IV Fluids

C – Calcium

B – Beta-2 Agonists

B – Bicarbonate

I – Insulin & Glucose

K – Kayexalate (Sodium Polystyrene Sulfonate)

D – Diuretics

D – Dialysis



1. First Step: Assess ECG & Risk of Arrhythmia

• Peaked T waves, QRS widening, sine wave = Give Calcium ASAP

• Calcium doesn’t lower K+, but it prevents cardiac arrest.

2. Temporary vs. Definitive Treatments

• Shifting K+ into cells (Beta-agonists, Bicarb, Insulin) buys time.

• Excreting K+ (Diuretics, Dialysis, Kayexalate) removes K+.

3. Timing of Interventions:

• Calcium: Immediate (stabilizes heart).

• Insulin/Albuterol/Bicarb: 15–30 min (shifts K+).

• Diuretics/Kayexalate: 1–6 hours (removes K+).

• Dialysis: Immediate, definitive.

4. Common Pitfalls & Pro Tips

• Insulin can cause hypoglycemia – recheck glucose in 30 minutes.

• Albuterol requires high doses – typical 2.5 mg nebs won’t cut it.

• Bicarb only works if acidotic – don’t rely on it in normotensive patients.

• Kayexalate is slow & controversial – consider patiromer or zirconium cyclosilicate instead in chronic cases.

• If oliguric or ESRD → Straight to dialysis.

Avsnitt(63)

Normocytic Anemia in the ED: Mind Palace for Emergency Medicine Rapid Recall (part 2)

Normocytic Anemia in the ED: Mind Palace for Emergency Medicine Rapid Recall (part 2)

Step aboard the Anemia Train and enter the Normocytic Skeleton Car—the middle car of your anemia mind palace—designed specifically for busy ED clinicians who need fast recall without flipping through ...

1 Aug 20251h 14min

Microcytic Anemia in the ED: What You’re Missing Could Kill Your Patient (part 1)

Microcytic Anemia in the ED: What You’re Missing Could Kill Your Patient (part 1)

Microcytic Anemia in the ED: What You’re Missing Could Kill Your Patient🚨 Episode Summary for the Emergency Clinician:Think you’ve got anemia figured out? Think again. In this high-yield episode, we ...

30 Juli 202553min

Low Platelet Emergencies: TTP, HUS, ITP, DIC, HELLP, HIT thrombocytopenia memory palace

Low Platelet Emergencies: TTP, HUS, ITP, DIC, HELLP, HIT thrombocytopenia memory palace

In this high-yield episode, we build a visual memory palace down the “Highway to Hell” of emergency thrombocytopenia syndromes. Each stop reveals a unique and dangerous cause of low platelets you’ll e...

24 Juli 20251h 7min

Warfarin vs Heparin: The Clotting Cascade Mind Palace for EM Docs (PT, PTT & TPA Simplified)

Warfarin vs Heparin: The Clotting Cascade Mind Palace for EM Docs (PT, PTT & TPA Simplified)

In this unforgettable bloody podcast, we bring the clotting cascade to life through a cast of hilarious and high-yield characters designed to make clinical recall effortless under pressure.Play Table ...

16 Juli 20251h 1min

STEMI Mimics: Elevation mnemonic

STEMI Mimics: Elevation mnemonic

In this episode, we tackle STEMI mimics—conditions that mimic ST-segment elevation myocardial infarction on an EKG but aren’t always a heart attack. Why’s it critical? Because ST elevation doesn’t alw...

10 Juli 202533min

Push-dose Epi: One out, One in - Makes 10

Push-dose Epi: One out, One in - Makes 10

How to Mix Push-dose Epi: One out, one in — makes tenGoal concentration: 10 mcg/mLStep-by-Step Mixing: 1. Start with a 10 mL syringe of normal saline (NS) • empty 1 mL to retain 9 mL of NS in the syri...

17 Juni 202523min

Postpartum Hemorrhage: E-MOTIVE

Postpartum Hemorrhage: E-MOTIVE

E-MOTIVE Mnemonic for Postpartum Hemorrhage: A Lifesaving StrategyThe E-MOTIVE mnemonic stands for a six-component bundle aimed at tackling postpartum hemorrhage (PPH), a major cause of maternal death...

14 Maj 202525min

Neonatal Resuscitation Algorithm flowchart: NRP

Neonatal Resuscitation Algorithm flowchart: NRP

This is a Neonatal Resuscitation Algorithm flowchart, specifically the NRP (Neonatal Resuscitation Program), published by the AHA in 2020. It provides a step-by-step guide for healthcare providers to ...

14 Maj 202518min

Populärt inom Hälsa

somna-med-henrik
rss-bara-en-till-om-missbruk-medberoende-2
rss-jossan-nina
inga-beiga-morsor
alska-oss
rss-vuxna-pa-latsas
brottarbroder
not-fanny-anymore
sexnoveller-deluxe
angestpodden
johannes-hansen-podcast
rss-viktmedicinpodden
sa-in-i-sjalen
sova-med-dan-horning
vinterpasset
rss-the-house-podcast-3
rss-sjalsligt-avkladd
tyngre-radio
rss-basta-livet
sex-pa-riktigt-med-marika-smith