Hyperkalaemia – insulin/dextrose — RACP Paediatrics MCQ

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ModerateEmergencyHyperkalaemia – insulin/dextroseRACP Paediatrics

After giving calcium gluconate, the same child's ECG has normalised but potassium remains 7.5 mmol/L. What is the most effective acute treatment to shift potassium intracellularly?

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Correct answer: B — IV insulin + dextrose

IV insulin (0.1 units/kg) with dextrose (2 mL/kg of 25% dextrose or 5 mL/kg of 10% dextrose) is the most effective acute treatment for redistributing potassium intracellularly. It lowers potassium by 0.5-1.2 mmol/L within 15-30 minutes. Nebulised salbutamol (2.5-5 mg) provides additional potassium shifting and can be given concurrently. Blood glucose must be monitored closely.

Reference: RCH Melbourne – 2024 – Hyperkalaemia CPG; RACP Paediatric Curriculum – Emergency