Unique Plan Description: Hyperkalemia Protocol
Plan Selection Display: Hyperkalemia Protocol
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2012-01-13 10:33:32
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2023-12-18 13:22:40
Available at all facilities: Yes

Hyperkalemia Protocol
Diagnostic Tests
	ECG
		T;N, Stat, Indication: Arrhythmia
IV Solutions
	Dextrose 10% 1000 mL w/ insulin regular 10 units
		1,000 mL, IV, Routine, T;N, 50 ml/hr
		10 units, EVERY BAG, 1 units/hr
	Dextrose 5% with 0.45% NaCl
		1,000 mL, IV, Routine, 100 ml/hr
Medications
		Discontinue any oral potassium and/or potassium IV additives already ordered(NOTE)*
	insulin regular
		10 units, Solution-Injection, IV Push, Once, STAT
			Comment: give before Dextrose
	Dextrose 50%
		50 mL, Injection, IV Push, Once, STAT
			Comment: If blood glucose < or = to 250mg/dL
	albuterol concentrate 2.5mg/0.5mL (0.5%) inh soln
		2 mL, Solution-Nebulization, NEBULIZED, Once, STAT
		4 mL, Solution-Nebulization, NEBULIZED, Once, STAT
	sodium chloride 0.9% inhalation solution
		3 mL, Solution-Nebulization, NEBULIZED, Once, STAT
		4 mL, Solution-Nebulization, NEBULIZED, Once, STAT
		Consider calcium for K+ >6.5mEq/L OR clinical signs or symptoms (cardiac conduction abnormalities, arrhythmias including bradycardia, sinus arrest, slow IVR, ventricular tachycardia, ventricular fibrillation, and asystole, muscle weakness or paralysis)(NOTE)*
	calcium gluconate
		2 gm, Solution, IV Push, Once, STAT
			Comment: Give over 3-5 minutes
		1 gm, Solution, IV Push, Once, STAT
			Comment: Give over 3-5 minutes
	calcium chloride
		1 gm, Syringe, IV Push, Once, STAT
			Comment: Give over 3-5 minutes; may cause vein irritation
	sodium bicarbonate 8.4%
		50 mEq, Injection, IV Push, Once, STAT
			Comment: Use with caution in dialysis patients
		100 mEq, Injection, IV Push, Once, STAT
			Comment: Use with caution in dialysis patients
	sodium polystyrene sulfonate
		15 gm, Suspension, By Mouth, Once, STAT
		30 gm, Suspension, By Mouth, Once, STAT
		60 gm, Suspension, By Mouth, Once, STAT
	Lokelma
		5 gm, Suspension, By Mouth, Once, STAT
		10 gm, Suspension, By Mouth, Once, STAT
Patient Care
	Cardiac Telemetry Monitoring
		T;N, Telemetry Indications: Electrolyte disorder
			Comment: Verify rhythm on initiation. Constant Indicator
	Order Lab
		T;N, K+ level 1 and 4 hrs after treatment complete
	Glucose POC - RN
		T;N
			Comment: Prior to insulin admistration and 15 min after insulin administration
		T;N+15
			Comment: 15 minutes after insulin administration
		T;N+60
			Comment: 1hr after insulin administration
	Notify MD
		Call MD if no improvement in EKG after calcium chloride administration.

*Report Legend:
DEF - This order sentence is the default for the selected order
GOAL - This component is a goal
IND - This component is an indicator
INT - This component is an intervention
IVS - This component is an IV Set
NOTE - This component is a note
Rx - This component is a prescription
SUB - This component is a sub phase