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Three Part Question

In [adults (>16 years) presenting to the emergency department with hyperkalaemia] is [Intravenous calcium gluconate more effective than intravenous calcium chloride] 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 wonder whether you should prescribe calcium chloride or calcium gluconate, as you're not sure which is more effective.

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
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.] AND [calcium gluconate.mp/ OR exp Calcium Gluconate/] Limit to (english language and humans yr="2003 -Current")

CINAHL: [Hyperkalaemia/ OR Hyperkalemia/ OR Hyperkal*/ OR High potassium/ OR Potassium/ OR Hyperpotass*) AND (Calcium gluconate] AND [calcium chloride/ OR CaCl2] Limit to (english language and humans)

Search Outcome

COCHRANE:51 papers found, 1 of which was relevant - search strategy dated to 2003.
MEDLINE: 0 papers found
EMBASE:37 papers found, none of which were relevant.
CINAHL:1 paper found, and not relevant to the clinical question.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Mahoney BA, Smith WA, Lo D, Tsoi K, Tonelli M, Clase C 2005 Canada	RCTs, quasi-RCTs and randomised cross-over studies were included.	Systematic review. 1a	Serum potassium, ECG changes, arrhythmia, adverse effects of therapy and death.	No relevant studies identified.

Comment(s)

There is no clinical evidence to support the use of either intravenous calcium gluconate or intravenous calcium chloride in the emergency management of hyperkalaemia.

Clinical Bottom Line

As there is no clinical evidence available, local guidelines and advice should be followed.

References

1. Mahoney BA, Smith WA, Lo D, Tsoi K, Tonelli M, Clase C Emergency interventions for hyperkalaemia Cochrane Database of Systematic Reviews 2005, Issue 2