[sirI]

Excuse me. The action is that of antagonizing, not shifting. Aplogies for the incorrect wording above.

Calcium does correct a hyperkalemia. Is utilized for severe hyperkalemia. Removal total body potassium should be further utilized.

I think we are on the same page about this, platon20. There are several methods of reducing hyperkalemia; some are utilized best pre-arrest and others are best utilized during arrest.

[nursejill155]

Insulin during a code is not per ACLS protocol....BUT I have given it during a code. I am sure your teacher was probably talking about if a pt has a high potassium, which may cause them to code, give insulin, D50 and Calcium, which would hopefully bring the K down. Its a quick fix for a high potassium. I once gave it when a pt K was 8.8, in which at that point she was in an idioventricular rhythm. Hope that helps.

[TopherSRN]

Originally Posted by sirI

Excuse me. The action is that of antagonizing, not shifting.

Originally Posted by sirI

Calcium does correct a hyperkalemia.

Your 2 quotes are contradictory. Ca has absolutely 0 effect on the potassium level. It only acts to normalize the normal resting membrane potential thereby rturning myocyte excitability to a more normal level. It is more of a cardioprotective measure than a corrective.

You can give all the calcium in the world to a pt with a K of 8.1 and their K will stay 8.1, you will only help to prevent arrythimias steming from the hyperkalemia.

Intracellular shifting agents such as NAHCO3, Insulin and High dose albuterol are the quickest and most effective way to get a K down. Exchange resins (kayexalate) are a more protracted treatment and not appropriate in a code.


And there is STILL a lot of misinformation in this thread.

[sirI]

Originally Posted by TopherSRN

Your 2 quotes are contradictory. Ca has absolutely 0 effect on the potassium level. It only acts to normalize the normal resting membrane potential thereby rturning myocyte excitability to a more normal level. It is more of a cardioprotective measure than a corrective.

You can give all the calcium in the world to a pt with a K of 8.1 and their K will stay 8.1, you will only help to prevent arrythimias steming from the hyperkalemia.

Intracellular shifting agents such as NAHCO3, Insulin and High dose albuterol are the quickest and most effective way to get a K down. Exchange resins (kayexalate) are a more protracted treatment and not appropriate in a code.


And there is STILL a lot of misinformation in this thread.

Calcium (chloride) is indicated for hyperkalemia during a code. And, it is indicated first line for severe hyperkalemia.

It acts as has been pointed out, to stablize the cell membrane and allow time to shift potassium intracellularly. I agree that its administration alone will not reduce the hyperkalemia.

[TopherSRN]

"Calcium (chloride) is indicated for hyperkalemia during a code. And, it is indicated first line for severe hyperkalemia."

Why do you keep repeating this? Its cookbook medicine and not even the point I was making. You were incorrect in saying that Ca corrects hyperkalemia, when it in fact does NOT. Its a bandaid fix that treats the symptoms, and not the problem. Im well aware of its indications.

Gluconate can be used, its largely MD preference (one of our surgeons preferred it in a non-emergent situation), but CaCl has roughly 3x the elemental Ca.

[sirI]

Gluconate can be used, but CaCl has roughly 3x the elemental Ca.

Yes, I, too am very well aware of this (thus my placing 'choride' in brackets above to indicate only one).

[ghillbert]

Wow "topherSRN", you're very aggressive. Chill out.

[nursejill155]

I agree, calm down topher, we get it.

[shadow92182]

Hyperglycemia can be a cause of PEA and therefor would require the use of IV insulin during the code?

[Chayo1989]

I've only given insulin during cardiac arrest once. The patient was known to be hyperkalemic, and i an effort to decrease the potassium the patient was given an amp of D50% and 10 units of regular insulin iv. This was implemented in addition to ACLS protocol.