Hyperkalaemia
Paediatric emergency management · Electrolyte · Metabolic
Confirm (exclude haemolysed sample) and get an ECG. Peaked T waves, widened QRS or arrhythmia require immediate treatment.
Stabilise the myocardium
Calcium gluconate 10%0.5 mL/kg IV over 5–10 min (max 20 mL)Maximum 20 mL
Shift potassium into cells
- Salbutamol nebuliser; insulin 0.1 U/kg with 2–5 mL/kg of 10% glucose (monitor glucose).
- Sodium bicarbonate if acidotic.
Remove potassium
- Cation-exchange resin, loop diuretic if making urine, and dialysis for refractory or renal-failure cases.
Common questions
What is the first step in hyperkalaemia?
Confirm (exclude haemolysed sample) and get an ECG. Peaked T waves, widened QRS or arrhythmia require immediate treatment.
What drug doses are used in hyperkalaemia?
Calcium gluconate 10%: 0.5 mL/kg IV over 5–10 min (max 20 mL).
About this page
Compiled from standard paediatric references. Verify against a current formulary and your local protocol.
Spotted something wrong? Report an error on this page — corrections from clinicians are welcome and are reviewed before any change is published.
Last reviewed 2026-08-12.