Beautiful post. You also covered the lastest article in Critical Care Medicine which proved calcium does not actually stabilise membrane which has been the traditional teaching for decades. One thing to add is: Even in acidotic patients, giving hypertonic bicarbonate doesn't reduce potassium levels. You need to give it as an isotonic solution, otherwise the hypertonicity pulls potassium out of cells, the reverse of which is the mechanism by which bicarbonate works, thereby cancelling each other and potassium levels remain same.
This is so interesting. I didn't know about the ECG correlation to Ca gluconate use. The post is succinct and resourceful. Looking forward to next Hyper K case .
yes If ECG changes like rhythm disturbances and QRS disturbances persist after 1st dose of calcium gluconate upto 3gm we can give, i.e. 3 bolus . and yes you give calcium only till the ECG changes mentioned above persist, once they are gone, u start giving other to lower potassium, and monitor patient carefully for repeat ecg changes
Is there a maximum dose of Ca gluconate ?. If we give 1g of Ca gluconate and ECG changes are corrected then can we stop giving Ca gluconate?And if ECG changes persist then do we have repeat Ca ?
Beautiful post. You also covered the lastest article in Critical Care Medicine which proved calcium does not actually stabilise membrane which has been the traditional teaching for decades. One thing to add is: Even in acidotic patients, giving hypertonic bicarbonate doesn't reduce potassium levels. You need to give it as an isotonic solution, otherwise the hypertonicity pulls potassium out of cells, the reverse of which is the mechanism by which bicarbonate works, thereby cancelling each other and potassium levels remain same.
Thank you for such valuable feedback.
About Isotonic bicarb thing , true .
next post coming on bicarb myths soon.
Will include in that
This is so interesting. I didn't know about the ECG correlation to Ca gluconate use. The post is succinct and resourceful. Looking forward to next Hyper K case .
Best of luck for the next patient.
Have fun on the floor!
Help patients as much as possible.
yes If ECG changes like rhythm disturbances and QRS disturbances persist after 1st dose of calcium gluconate upto 3gm we can give, i.e. 3 bolus . and yes you give calcium only till the ECG changes mentioned above persist, once they are gone, u start giving other to lower potassium, and monitor patient carefully for repeat ecg changes
Is there a maximum dose of Ca gluconate ?. If we give 1g of Ca gluconate and ECG changes are corrected then can we stop giving Ca gluconate?And if ECG changes persist then do we have repeat Ca ?
If K is 6.5 and the only ECG change is Peaked T waves then Ca can skipped and correction has to be done with only insulin, right?
calcium only if ECG changes mentioned in the post are present, according to the new literature , where they explain how calcium actually helps ?
https://doi.org/10.1097/ccm.0000000000006376. - refer this