title: Continuous infusion of a standard combination solution in the management of hyperkalemia.
abstract: BACKGROUND
  Hyperkalemia, due to its effect on cardiac conductivity, is a potentially life-threatening electrolyte abnormality. Multiple therapeutic agents may be used alone or in combination for its prompt management.
  
  
  METHODS
  We report on the safety and efficacy of continuous infusion of a solution containing fixed concentrations of calcium gluconate, insulin, dextrose and sodium acetate (HyperK-Cocktail) for the treatment of hyperkalemia. This solution is prepared at our institution and is infused parenterally until the plasma potassium level stabilizes. Twenty-one consecutive hyperkalemic patients managed with HyperK-Cocktail on 23 occasions are reported.
  
  
  RESULTS
  None of the subjects had intravenous extravasation injuries, hypernatremia, hypocalcemia, hypercalcemia or alkalosis during HyperK-Cocktail infusion. Transient hyperglycemia developed in nine subjects and hypoglycemia in one subject. The decrease in serum potassium was similar in the initial hour when compared to prior studies using a beta-agonist and/or insulin and glucose; a larger decrease was present from 2 to 8 h with the HyperK-Cocktail. The plasma potassium decreased by a mean of 1.0, 1.7, 2.1 and 2.1 mmol/L at 1, 2, 4 and 8 h, respectively. The mean serum potassium at hours 1-8 was significantly lower than the initial level.
  
  
  CONCLUSIONS
  The results of our study demonstrated that HyperK-Cocktail is a safe and effective combination therapy for children with hyperkalemia.
authors.affiliation: Division of Nephrology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
authors.forename: Halima S
authors.initials: HS
authors.lastname: Janjua
authors.forename: John D
authors.initials: JD
authors.lastname: Mahan
authors.forename: Hiren P
authors.initials: HP
authors.lastname: Patel
authors.forename: Mark
authors.initials: M
authors.lastname: Mentser
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Schwaderer
mesh_terms: D000293:Adolescent; D002125:Calcium Gluconate / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D019468:Disease Management; D005260:Female; D005947:Glucose / Q000008:administration & dosage*; D006801:Humans; D006947:Hyperkalemia / Q000188:drug therapy*; D007223:Infant; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D019346:Sodium Acetate / Q000008:administration & dosage*; D012996:Solutions
chemical_list: D007328:Insulin; D012996:Solutions; D019346:Sodium Acetate; D005947:Glucose; D002125:Calcium Gluconate