Which treatment is recommended for severe hyperkalemia?

In the management of severe hyperkalemia, both calcium gluconate and insulin with glucose are important components of therapy.

Calcium gluconate is used because it stabilizes the cardiac membrane effects of hyperkalemia, reducing the risk of life-threatening arrhythmias. High potassium levels can lead to changes in the resting membrane potential of cardiac cells, increasing excitability and the risk of arrhythmias. Administering calcium gluconate counteracts these effects, providing protective effects on the heart.

Insulin, often given along with glucose, is effective in promoting the intracellular uptake of potassium. Insulin stimulates the Na+/K+ ATPase pump, which drives potassium into the cells, thereby lowering serum potassium levels. Glucose is administered with insulin to prevent hypoglycemia, which can occur as a side effect of insulin administration.

Together, these treatments are critical in the acute management of severe hyperkalemia. There are additional measures that may be employed, such as administering diuretics or dialysis in cases of renal failure, but in terms of immediate interventions to address the life-threatening aspects of severe hyperkalemia, calcium gluconate and insulin with glucose are the recommended approaches.