The use of calcium gluconate in the treatment of hyperkalaemia.
Date First Published:
June 28, 2011
Last Updated:
August 11, 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 gluconate] effective at [preventing cardiac arrhythmias]?
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.
You consider prescribing calcium gluconate, but wonder what effect this will achieve.
You consider prescribing calcium gluconate, but wonder what effect this will achieve.
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 26th 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 26th 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 gluconate.mp./ OR exp Calcium Gluconate/] Limit to (english language and humans and yr="2003 -Current")
CINAHL: (Hyperkalaemia/ OR Hyperkalemia/ OR Hyperkal*/ OR High potassium/ OR Potassium/ OR Hyperpotass*) AND (Calcium gluconate) Limit to (human and english language)
MEDLINE and EMBASE: [exp Potassium/ OR exp Hyperkalemia/ OR hyperkalaemia.mp/ OR high potassium.mp/ OR hyperkal$.mp/ OR hyperpotass$.mp] AND [calcium gluconate.mp./ OR exp Calcium Gluconate/] Limit to (english language and humans and yr="2003 -Current")
CINAHL: (Hyperkalaemia/ OR Hyperkalemia/ OR Hyperkal*/ OR High potassium/ OR Potassium/ OR Hyperpotass*) AND (Calcium gluconate) Limit to (human and english language)
Outcome:
COCHRANE: 51 papers were identified, 1 of which was relevant - search strategy dated up to 2003.
MEDLINE: 24 papers found, none of which were relevant.
EMBASE: 258 papers found, none of which were relevant.
CINAHL: 4 papers found, none of which were relevant.
MEDLINE: 24 papers found, none of which were relevant.
EMBASE: 258 papers found, none of which were relevant.
CINAHL: 4 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 intravenous calcium gluconate 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