# Hyperkalaemia (mild to moderate) - Category: acute - Review status: reviewed (every claim checked against a document named on this page) - Sources: KDIGO Clinical Practice Guideline for Acute Kidney Injury 2012 · Egyptian National Drug Formulary - Cardiovascular 2024 (furosemide monograph) · Calcium Resonium (calcium polystyrene sulfonate) SmPC sections 4.2-4.4 (eMC product 1439) · Hyperkalemia - StatPearls - NCBI Bookshelf (NBK470284) - disease-level clinical article - Verified date: 2026-08 ## Verified against - Calcium Resonium (calcium polystyrene sulfonate) SmPC sections 4.2-4.4 (eMC product 1439) - Egyptian National Drug Formulary - Cardiovascular 2024 (furosemide monograph) - Hyperkalemia - StatPearls - NCBI Bookshelf (NBK470284) - disease-level clinical article ## Treatment metadata - Calcium polystyrene sulphonate — 15000 mg — oral.liquid - Furosemide — 40 mg — injection ## Complete treatment card ```text HYPERKALAEMIA (MILD TO MODERATE) Sources: KDIGO Clinical Practice Guideline for Acute Kidney Injury 2012 · Egyptian National Drug Formulary - Cardiovascular 2024 (furosemide monograph) · Calcium Resonium (calcium polystyrene sulfonate) SmPC sections 4.2-4.4 (eMC product 1439) · Hyperkalemia - StatPearls - NCBI Bookshelf (NBK470284) - disease-level clinical article Review status: REVIEWED against 3 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (3) - Mild to moderate rises usually cause nothing at all - It is often picked up on bloods taken for vague complaints, or when checking electrolytes after infection, dehydration or poor perfusion [dehydration] - When there are symptoms they are weakness, tiredness, palpitations or fainting [fatigue · palpitations · syncope] SIGNS - what you find (3) - Raised blood pressure and oedema where there is kidney disease, and there may be signs of poor perfusion [hypertension · oedema] - Tender muscles point to rhabdomyolysis, while jaundice points to a haemolytic cause [jaundice · muscle pain] - Nerve and muscle effects: widespread weakness, floppy paralysis, and reduced tendon reflexes [paralysis] TESTS (12) - Do an ECG first, because the dangerous complication is a cardiac arrhythmia that can kill suddenly - ECG changes track the level: 5.5 to 6.5 tall peaked T waves; 6.5 to 7.5 P waves flatten or vanish; 7 to 8 the QRS widens; 8 to 10 severe arrhythmia, a sine wave, then asystole - How fast the potassium rose matters more than the number: a chronic case can have a near- normal ECG at a high level, an acute shift a very abnormal one at a lower level - Typical tracing: small or absent P waves, a long PR interval, taller R waves, a wide QRS and peaked T waves - Urea and creatinine for kidney function, with urinalysis to screen for kidney disease; urine potassium, sodium and osmolality can point to the cause - Check calcium where the kidneys are impaired, since a low calcium worsens the effect on the heart - A full blood count looks for a raised white cell or platelet count - Glucose and a blood gas in diabetes or when metabolic acidosis is suspected - LDH when haemolysis is suspected; creatine phosphokinase and urine myoglobin when muscle breakdown is - Uric acid and phosphate in anyone at risk of tumour lysis, and a digoxin level in anyone taking digoxin - If no cause emerges, measure cortisol and aldosterone to look for mineralocorticoid deficiency - A falsely high result is common, so confirm the level in a well patient with a normal ECG before treating hard IF NOT THIS - what else fits (12) - Underlying causes to consider: kidney disease, diabetes, chemotherapy, major trauma, a crush injury, and muscle breakdown - Drug and intake causes: digoxin, potassium-sparing diuretics, NSAIDs, ACE inhibitors, intravenous potassium, parenteral nutrition, potassium penicillin and suxamethonium - Acute tubular necrosis - Congenital adrenal hyperplasia - Digitalis toxicity - Electrical burn injury - Head trauma - Low serum calcium - Metabolic acidosis - Rhabdomyolysis - Thermal burns - Tumour lysis syndrome Source StatPearls "Hyperkalemia" - disease-level clinical article Status traced to the source above 1. CALCIUM POLYSTYRENE SULPHONATE [1st line] Adult 15 g 3 to 4 times daily in water Peds 500-1000 mg/kg/day (Give in divided doses; monitor electrolytes closely) 3kg -> 1500-3000 mg/day 4kg -> 2000-4000 mg/day 5kg -> 2500-5000 mg/day 6kg -> 3000-6000 mg/day 7kg -> 3500-7000 mg/day 8kg -> 4000-8000 mg/day 9kg -> 4500-9000 mg/day 10kg -> 5000-10000 mg/day 11kg -> 5500-11000 mg/day 12kg -> 6000-12000 mg/day 13kg -> 6500-13000 mg/day 14kg -> 7000-14000 mg/day 15kg -> 7500-15000 mg/day 16kg -> 8000-16000 mg/day 17kg -> 8500-17000 mg/day 18kg -> 9000-18000 mg/day 19kg -> 9500-19000 mg/day 20kg -> 10000-20000 mg/day 21kg -> 10500-21000 mg/day 22kg -> 11000-22000 mg/day 23kg -> 11500-23000 mg/day 24kg -> 12000-24000 mg/day 25kg -> 12500-25000 mg/day 26kg -> 13000-26000 mg/day 27kg -> 13500-27000 mg/day 28kg -> 14000-28000 mg/day 29kg -> 14500-29000 mg/day 30kg -> 15000-30000 mg/day 31kg -> 15500-31000 mg/day 32kg -> 16000-32000 mg/day 33kg -> 16500-33000 mg/day 34kg -> 17000-34000 mg/day 35kg -> 17500-35000 mg/day 36kg -> 18000-36000 mg/day 37kg -> 18500-37000 mg/day 38kg -> 19000-38000 mg/day 39kg -> 19500-39000 mg/day 40kg -> 20000-40000 mg/day 41kg -> 20500-41000 mg/day 42kg -> 21000-42000 mg/day 43kg -> 21500-43000 mg/day 44kg -> 22000-44000 mg/day 45kg -> 22500-45000 mg/day 46kg -> 23000-46000 mg/day 47kg -> 23500-47000 mg/day 48kg -> 24000-48000 mg/day 49kg -> 24500-49000 mg/day 50kg -> 25000-50000 mg/day Source Calcium Resonium (calcium polystyrene sulfonate) SmPC sections 4.2-4.4 (eMC product 1439) Why Cation-exchange resin that binds potassium in the gut in exchange for calcium, lowering serum potassium by increasing faecal excretion; used for mild-to-moderate hyperkalaemia when a slower-acting oral measure is appropriate. Caution Avoid in obstructive bowel disease. Suspend it in water or syrup - never fruit juice. Fruit juice is loaded with potassium and undoes the whole point of giving it. It has caused bowel stenosis, ischaemia, necrosis and perforation, some of them fatal. If the patient becomes significantly constipated, stop until the bowels move again. Never alongside sorbitol - that combination is the one most tied to intestinal necrosis. Not if the potassium is already below 5 mmol/L, not in obstructive bowel disease, and never by mouth in a neonate. Children: 1 g/kg/day in divided doses for acute hyperkalaemia, 0.5 g/kg/day to maintain. There is a risk of intestinal necrosis and constipation. Egypt RENOSTRITE POWDER FOR ORAL/RECTAL USE 500 GM IDI > MIRA INTERNATIONAL 627.50 EGP -> ? strength differs, ? different route - not oral liquid SORBISTERIT POWDER 500 GM FRESENIUS KAB... 867.00 EGP -> ? strength differs, ? different route - not oral liquid 2. FUROSEMIDE [add-on - not a substitute] Adult 40 mg intravenously every 12 hours, or by continuous infusion Peds The cited article gives an adult intravenous regimen only and records no paediatric dose for hyperkalaemia; a child with hyperkalaemia needs urgent hospital assessment. Source Hyperkalemia - StatPearls - NCBI Bookshelf (NBK470284) - disease-level clinical article Why Loop diuretic that promotes renal potassium excretion, added alongside potassium-binding therapy in a volume-overloaded patient with preserved renal function; it does not replace urgent hospital referral if potassium is severely elevated or ECG changes are present. Caution These agents may be administered in nonoliguric, volume-overloaded patients but should not be used as monotherapy in symptomatic hyperkalemia. Severe hyperkalaemia (>6.5 mmol/L or ECG changes) requires urgent hospital referral. In euvolaemia or hypovolaemia with preserved renal function, isotonic saline is given as needed before the 40 mg intravenous dose. Monitor blood pressure and renal function. Egypt FUROSEMIDE 40MG/4ML 3 AMP. SEDICO 6.50 EGP LASIPHAR 40MG/4ML I.M./I.V. 3 AMPS. EIMC > PHAROPHARMA 6.50 EGP DIUSEX 40MG/4ML 5 AMP. GLOBAL NAPI P... 13.50 EGP LAFUREX 40MG/4ML 3 AMP. AMOUN 13.50 EGP FUROSEMIDE-ALEX 40MG 5 I.M. I.V. AMP. ALEXANDRIA 50.00 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)