382 Pediatr Nephrol (2011) 26:377–384 Potassium >5.5 mmol/l → Repeat samples if factitious hyperkalemia suspected GFR <15ml/min/1.73m2 GFR >15ml/min/1.73m2 Decreased renal potassium excretion - Acute renal failure - Chronic renal failure - Drugs Increased potassium load Aldosterone low Aldosterone high * - Supplementation (oral/iv) - Potassium rich diet - Blood transfusion - Tumor lysis/ hemolysis Renin low Renin normal Renin high Post renal transplant Obstructive uropathy Sickle-cell nephropathy Drugs PHA type 1/ type 2 Type 1 RTA Hyporeninemic hypoaldosteronism in: Interstitial nephritis Obstructive uropathies Drugs Diabetic nephropathy Primary hypoaldosteronism Congenital adrenal hyperplasia Drugs Addison‘s/congenital adrenal hypoplasia * Calculating TTKG +/- adminstration of fludrocortisone may help in distinguishing patients who have mineralocorticoid deficiency versus mineralocorticoid resistance (table 3). Fig. 1 Diagnostic algorithm in hyperkalemia; adapted from Clinical Paediatric Nephrology. Used with permission from [40] RTA renal tubular acidosis Table 4 Drugs used for treatment of hyperkalemia Drug Dextrose/insulin Salbutamol (ten drops of standard sabutamol inhalation solution contain 2.5 mg) Sodium bicarbonate 8.4% Furosemide Ion exchange resins Ca-Gluconate 10% Dose 2.5-5 ml/kg/h 20% dextrose (0.5-1 g/kg/h) with insulin 0.2 units for every gram of glucose administered iv: 4-5 μg/kg in 15 ml of 5% dextrose/ water, short infusion over 15 min Nebulized: 2.5 mg if <25 kg and 5 mg if >25 kg 1-2 mmol/kg over 30-60 min or calculated on base-deficit 1-2 mg/kg Given p.o. or p.r. calcium resonium 1 g/kg sodium resonium 1 g/kg 0.5–1 ml/kg over 5-10 min, preferably ad- ministered via central venous access Rapidity of action Fast Fast Slow Intermediate Sodium load (hypertension) Intermediate Ototoxicity, nephrotoxicity Side-effects/complications Hypoglycemia, hyperosmolarity, volume overload Tachycardia p.o.: nausea, constipation or even paralytic ileus. Diarrhea if preparations come premixed with sorbitol p.r.: cecal perforation Hypercalcemia, tissue necrosis NOTE: Ca-Gluconate does not have a potassium-lowering effect