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1. Resonium is a cation-exchange resin given orally or as an enema that exchanges Na + for K + across the gut wall and also induces an osmotic diarrhea full of potassium.

2. IV calcium gluconate (peripheral injection) or IV calcium chloride (requires central access); use only if there is a wide QRS or absence of P waves. IV calcium can enhance the effect of digoxin; therefore do not give to patients on this therapy.

3. Insulin with glucose infusion (15 minutes for effect).

4. Sodium bicarbonate injection or infusion, if acidosis is present (30 minutes for effect; minimal response in patients without acidosis). Can precipitate decompensated heart failure.

5. Albuterol nebulization (90 minutes for effect) or injection (30 minutes for effect), but be careful in patients with heart disease.

6. Loop diuretics (in patients who make urine).

7. Dialysis.


1. Wilkinson, I. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press.
2. Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
3. Image: no reference available.

Ⓒ A. Manickam 2018

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