The use of calcium chloride in the treatment of hyperkalaemia.
Date First Published:
June 28, 2011
Last Updated:
July 7, 2011
Report by:
Jennifer Wright, Medical Student (University of Manchester)
Three-Part Question:
In [adults (>16 years) presenting to the emergency department with hyperkalaemia] is
[intravenous calcium chloride] effective at [lowering serum K+ levels]?
Clinical Scenario:
A 65 year-old man is referred to the ED by his GP with a serum potassium concentration of 6.5mmol/L. Repeat tests confirm hyperkalaemia. You order an ECG which shows characteristic hyperkalaemic changes.
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Search Strategy:
Cochrane Library for Systematic Reviews: May 2011
MEDLINE using OVID interface: 1948 to June week 2
EMBASE: 1980 to 2011 week 24
Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus: 1947 to June 25th 2011
MEDLINE using OVID interface: 1948 to June week 2
EMBASE: 1980 to 2011 week 24
Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus: 1947 to June 25th 2011
Search Details:
COCHRANE: hyperkalaemia, hyperkalemia, hyperkal*, hyperpotass*, potassium and hyperpotassaemia
MEDLINE and EMBASE: [exp Potassium/ OR exp Hyperkalemia/ OR hyperkalaemia.mp/ OR high potassium.mp/ OR hyperkal$.mp/ OR hyperpotass$.mp] AND [calcium chloride.mp./ OR exp Calcium Chloride/ OR CaCl2.mp.] Limit to (english language and humans yr="2003 -Current")
CINAHL: (Hyperkalaemia/ OR Hyperkalemia/ OR Hyperkal*/ OR High potassium/ OR Potassium/ OR Hyperpotass*) AND (Calcium chloride/ OR CaCl2) Limit to (english language and humans)
MEDLINE and EMBASE: [exp Potassium/ OR exp Hyperkalemia/ OR hyperkalaemia.mp/ OR high potassium.mp/ OR hyperkal$.mp/ OR hyperpotass$.mp] AND [calcium chloride.mp./ OR exp Calcium Chloride/ OR CaCl2.mp.] Limit to (english language and humans yr="2003 -Current")
CINAHL: (Hyperkalaemia/ OR Hyperkalemia/ OR Hyperkal*/ OR High potassium/ OR Potassium/ OR Hyperpotass*) AND (Calcium chloride/ OR CaCl2) Limit to (english language and humans)
Outcome:
COCHRANE: 51 papers, one of which was relevant (search strategy dated to 2003)
MEDLINE: 17 papers found, none of which were relevant.
EMBASE: 132 papers found, none of which were relevant.
CINAHL:30 papers found, none of which were relevant.
MEDLINE: 17 papers found, none of which were relevant.
EMBASE: 132 papers found, none of which were relevant.
CINAHL:30 papers found, none of which were relevant.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Emergency interventions for hyperkalaemia Mahoney BA, Smith WA, Lo D, Tsoi K, Tonelli M, Clase C 2005 Canada | RCTs, quasi- RCTS and randomised cross-over studies. | Systematic review. 1a | Serum potassium, ECG changes, arrhythmia, adverse effects of therapy and death. | No relevant studies identified. |
Author Commentary:
There is no clinical evidence for or against the use of calcium chloride in the emergency management of hyperkalaemia.
Bottom Line:
As there is no clinical evidence available, local guidelines and advice should be followed.
References:
- Mahoney BA, Smith WA, Lo D, Tsoi K, Tonelli M, Clase C. Emergency interventions for hyperkalaemia