Podcast 1015: Calcium in Hyperkalemia

Hyperkalemia presents a critical medical emergency where elevated potassium levels threaten to cause cardiac arrest, necessitating a structured three-step treatment approach. Calcium serves as the immediate first-line intervention, available as calcium gluconate for stable patients or calcium chloride for emergent cases with EKG changes like QRS widening or sine waves. While traditionally described as a "membrane stabilizer," recent research in canine myocytes suggests calcium actually functions through specific cardiac channels to restore normal rhythms. Following stabilization, treatment shifts to moving potassium into cells using insulin with dextrose, bicarbonate, or high-dose albuterol. The final phase involves removing potassium from the body via dialysis, loop diuretics like Lasix to induce urinary excretion, or gastrointestinal binders like Lokelma. Because calcium’s effects are transient, lasting only about 30 minutes, repeated dosing is often required while waiting for slower-acting shifting and excretion therapies to take effect.