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Hyperkalemia Order Set (Potassium Level (mEq/L)? (Hemolyzed? (No (5.1 - 5…

- - - - ^ Refer back to beginning of order set
    - - 5.1 - 5.4 + No EKG Changes
        
        Adjust/DC offending agents
        
        Assess diet
        
        Evaluate other causes (ie. underlying heart disease, cirrhosis, kidney disease)
        
        Recheck K+ Levels 12-24 hours afterwards
      - ≥ 5.5 + No EKG Changes
        
        Does pt need hemodialysis?
        
        Yes: Dialyze
        
        DC offending agents / Assess diet / Recheck K+ levels after hemodialysis
        
        No: Give acute therapy +/- Kayexalate
        
        1. Kayexalate 30g (Recommended for K+ between 5.5-6 mEq/L) / Shake the suspension prior to administration. Do not administer with orange juice. Chilling the suspension may improve palatability
        
        2. Insulin Lispro 10 units IV Push x 1 dose
        
        3. D50W 50 mL IV Push x 1 dose
        
        4. Albuterol 0.083% Inhalation 3 mL nebulizer q10mins x 3 doses
        
        5. Furosemide 40 mg IV push x 1 dose
        
        DC offending agents / Assess diet / Recheck K+ levels q2-4 hours / Check BGM once before administration of insulin and one hour after administration. If BGM is < 100 mg/dl, repeat in another hour.
      - ≥ 6.5, regardless of EKG
        
        Does pt need hemodialysis?
        
        Yes: Dialyze
        
        DC offending agents / Assess diet / Recheck K+ levels after hemodialysis
        
        No: CIGAR + Kayexalate
        
        1. Kayexalate 30g recommended for K+ between 5.5-6 mEq/L / Kayexalate 60g recommended for K+ > 6 mEq/L. Shake the suspension prior to administration. Do not administer with orange juice. Chilling the suspension may improve palatability
        
        2. Calcium Gluconate 1,000 mg IVP Push Q10minutes x 3 doses (Administer slowly into large vein) For EKG Changes ONLY
        
        3. Insulin Lispro 10 units IV Push x 1 dose
        
        4. D50W 50 mL IV Push x 1 dose
        
        5. Albuterol 0.083% Inhalation 3 mL nebulizer q10mins x 3 doses
        
        6. Furosemide 40 mg IV push x 1 dose
        
        7. DC offending agents / Assess diet / Recheck K+ levels q2-4 hours / Check BGM once before administration of insulin and one hour after administration. If BGM is < 100 mg/dl, repeat in another hour.
      - 5.1 - 5.4 + EKG Changes
        
        Does pt need hemodialysis?
        
        No: Give CIGAR therapy
        
        1. Calcium Gluconate 1,000 mg IVP Push Q10minutes x 3 doses (Administer slowly into large vein)
        
        2. Insulin Lispro 10 units IV Push x 1 dose
        
        3. D50W 50 mL IV Push x 1 dose
        
        4. Albuterol 0.083% Inhalation 3 mL nebulizer q10mins x 3 doses
        
        5. Furosemide 40 mg IV push x 1 dose
        
        DC offending agents / Assess diet / Recheck K+ levels q2-4 hours / Check BGM once before administration of insulin and one hour after administration. If BGM is < 100 mg/dl, repeat in another hour.
        
        Yes: Dialyze
        
        DC offending agents / Assess diet / Recheck K+ levels after hemodialysis
      - ≥ 5.5 + EKG Changes
        
        Does pt need hemodialysis?
        
        Yes: Dialyze
        
        DC offending agents / Assess diet / Recheck K+ levels after hemodialysis
        
        No: Give CIGAR +/- Kayexalate
        
        1. Kayexalate 30g recommended for K+ between 5.5-6 mEq/L / Kayexalate 60g recommended for K+ > 6 mEq/L. Shake the suspension prior to administration. Do not administer with orange juice. Chilling the suspension may improve palatability
        
        2. Calcium Gluconate 1,000 mg IVP Push Q10minutes x 3 doses (Administer slowly into large vein)
        
        3. Insulin Lispro 10 units IV Push x 1 dose
        
        5. Albuterol 0.083% Inhalation 3 mL nebulizer q10mins x 3 doses
        
        6. Furosemide 40 mg IV push x 1 dose
        
        7. DC offending agents / Assess diet / Recheck K+ levels q2-4 hours / Check BGM once before administration of insulin and one hour after administration. If BGM is < 100 mg/dl, repeat in another hour.
        
        4. D50W 50 mL IV Push x 1 dose