The use of calcium gluconate in the treatment of hyperkalaemia.

Report By: Jennifer Wright - Medical Student
Institution: University of Manchester
Date Submitted: 28th June 2011
Last Modified: 11th August 2011
Status: Blue (submitted but not checked)

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.

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
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)

Search 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.

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.	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 for or against the use of intravenous calcium gluconate in the emergency management of hyperkalaemia.

Clinical 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 Cochrane Database of Systematic Reviews 2005, Issue 2