Emergency treatment is indicated if the potassium is very high, or if severe symptoms are present, including changes in the ECG . Intravenous calcium may be given to temporarily counteract the muscular and cardiac effects of hyperkalemia, including paralysis or cardiac arrhythmias . Intravenous calcium will only counteract symptoms for about 1 hour, so other treatments should begin immediately. Intravenous glucose and insulin moves potassium from the extracellular fluids back into the cells. This may reverse severe symptoms long enough to allow correction of the cause of the hyperkalemia.
Sodium bicarbonate causes potassium to shift from extracellular to intracellular fluids.
It may reverse hyperkalemia caused by acidosis with no other treatment required. Prolonged use of sodium bicarbonate should be avoided because it may cause severe complications. Diuretic medications cause decrease in total body potassium. They may be prescribed for persons who can tolerate the loss of body fluid that accompanies use of a diuretic. These medications may be given orally or rectally.