Dawaa Reference

acute

Hyperkalaemia (mild to moderate)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources4 sources

KDIGO Clinical Practice Guideline for Acute Kidney Injury 2012 · Egyptian National Drug Formulary - Cardiovascular 2024 (furosemide monograph) · Calcium Resonium (calcium polystyrene sulfonate) SmPC sections 4.2-4.4 (eMC product 1439) · Hyperkalemia - StatPearls - NCBI Bookshelf (NBK470284) - disease-level clinical article

Verified against3 documents
  • Calcium Resonium (calcium polystyrene sulfonate) SmPC sections 4.2-4.4 (eMC product 1439)
  • Egyptian National Drug Formulary - Cardiovascular 2024 (furosemide monograph)
  • Hyperkalemia - StatPearls - NCBI Bookshelf (NBK470284) - disease-level clinical article

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (3)

  • Mild to moderate rises usually cause nothing at all
  • It is often picked up on bloods taken for vague complaints, or when checking electrolytes after infection, dehydration or poor perfusion [dehydration]
  • When there are symptoms they are weakness, tiredness, palpitations or fainting [fatigue · palpitations · syncope]

Signs — what you find (3)

  • Raised blood pressure and oedema where there is kidney disease, and there may be signs of poor perfusion [hypertension · oedema]
  • Tender muscles point to rhabdomyolysis, while jaundice points to a haemolytic cause [jaundice · muscle pain]
  • Nerve and muscle effects: widespread weakness, floppy paralysis, and reduced tendon reflexes [paralysis]

Tests (12)

  • Do an ECG first, because the dangerous complication is a cardiac arrhythmia that can kill suddenly
  • ECG changes track the level: 5.5 to 6.5 tall peaked T waves; 6.5 to 7.5 P waves flatten or vanish; 7 to 8 the QRS widens; 8 to 10 severe arrhythmia, a sine wave, then asystole
  • How fast the potassium rose matters more than the number: a chronic case can have a near-normal ECG at a high level, an acute shift a very abnormal one at a lower level
  • Typical tracing: small or absent P waves, a long PR interval, taller R waves, a wide QRS and peaked T waves
  • Urea and creatinine for kidney function, with urinalysis to screen for kidney disease; urine potassium, sodium and osmolality can point to the cause
  • Check calcium where the kidneys are impaired, since a low calcium worsens the effect on the heart
  • A full blood count looks for a raised white cell or platelet count
  • Glucose and a blood gas in diabetes or when metabolic acidosis is suspected
  • LDH when haemolysis is suspected; creatine phosphokinase and urine myoglobin when muscle breakdown is
  • Uric acid and phosphate in anyone at risk of tumour lysis, and a digoxin level in anyone taking digoxin
  • If no cause emerges, measure cortisol and aldosterone to look for mineralocorticoid deficiency
  • A falsely high result is common, so confirm the level in a well patient with a normal ECG before treating hard

If not this — what else fits (12)

  • Underlying causes to consider: kidney disease, diabetes, chemotherapy, major trauma, a crush injury, and muscle breakdown
  • Drug and intake causes: digoxin, potassium-sparing diuretics, NSAIDs, ACE inhibitors, intravenous potassium, parenteral nutrition, potassium penicillin and suxamethonium
  • Acute tubular necrosis
  • Congenital adrenal hyperplasia
  • Digitalis toxicity
  • Electrical burn injury
  • Head trauma
  • Low serum calcium
  • Metabolic acidosis
  • Rhabdomyolysis
  • Thermal burns
  • Tumour lysis syndrome

SourceStatPearls "Hyperkalemia" - disease-level clinical article

Presentation findings are traced to the source above.

1

CALCIUM POLYSTYRENE SULPHONATE

1st line

Strength15000 mg

Formoral.liquid

Adult dose and duration

15 g 3 to 4 times daily in water

Paediatric dose

500-1000 mg/kg/day

(Give in divided doses; monitor electrolytes closely)

Dose by weight
3kg1500-3000 mg/day
4kg2000-4000 mg/day
5kg2500-5000 mg/day
6kg3000-6000 mg/day
7kg3500-7000 mg/day
8kg4000-8000 mg/day
9kg4500-9000 mg/day
10kg5000-10000 mg/day
11kg5500-11000 mg/day
12kg6000-12000 mg/day
13kg6500-13000 mg/day
14kg7000-14000 mg/day
15kg7500-15000 mg/day
16kg8000-16000 mg/day
17kg8500-17000 mg/day
18kg9000-18000 mg/day
19kg9500-19000 mg/day
20kg10000-20000 mg/day
21kg10500-21000 mg/day
22kg11000-22000 mg/day
23kg11500-23000 mg/day
24kg12000-24000 mg/day
25kg12500-25000 mg/day
26kg13000-26000 mg/day
27kg13500-27000 mg/day
28kg14000-28000 mg/day
29kg14500-29000 mg/day
30kg15000-30000 mg/day
31kg15500-31000 mg/day
32kg16000-32000 mg/day
33kg16500-33000 mg/day
34kg17000-34000 mg/day
35kg17500-35000 mg/day
36kg18000-36000 mg/day
37kg18500-37000 mg/day
38kg19000-38000 mg/day
39kg19500-39000 mg/day
40kg20000-40000 mg/day
41kg20500-41000 mg/day
42kg21000-42000 mg/day
43kg21500-43000 mg/day
44kg22000-44000 mg/day
45kg22500-45000 mg/day
46kg23000-46000 mg/day
47kg23500-47000 mg/day
48kg24000-48000 mg/day
49kg24500-49000 mg/day
50kg25000-50000 mg/day
Dose source

Calcium Resonium (calcium polystyrene sulfonate) SmPC sections 4.2-4.4 (eMC product 1439)

Why

Cation-exchange resin that binds potassium in the gut in exchange for calcium, lowering serum potassium by increasing faecal excretion; used for mild-to-moderate hyperkalaemia when a slower-acting oral measure is appropriate.

Cautions
  • Avoid in obstructive bowel disease.
  • Suspend it in water or syrup - never fruit juice. Fruit juice is loaded with potassium and undoes the whole point of giving it.
  • It has caused bowel stenosis, ischaemia, necrosis and perforation, some of them fatal. If the patient becomes significantly constipated, stop until the bowels move again.
  • Never alongside sorbitol - that combination is the one most tied to intestinal necrosis.
  • Not if the potassium is already below 5 mmol/L, not in obstructive bowel disease, and never by mouth in a neonate.
  • Children: 1 g/kg/day in divided doses for acute hyperkalaemia, 0.5 g/kg/day to maintain.
  • There is a risk of intestinal necrosis and constipation.
Egyptian brands
Egyptian brandManufacturerIndicative price
RENOSTRITE POWDER FOR ORAL/RECTAL USE 500 GM? strength differs? different route - not oral liquidIDI > MIRA INTERNATIONAL627.50 EGP
SORBISTERIT POWDER 500 GM? strength differs? different route - not oral liquidFRESENIUS KABI > EGYPTIAN GROUP FOR IMPORT AND EXPORT867.00 EGP
2

FUROSEMIDE

add-on - not a substitute

Strength40 mg

Forminjection

Adult dose and duration

40 mg intravenously every 12 hours, or by continuous infusion

Paediatric dose

The cited article gives an adult intravenous regimen only and records no paediatric dose for hyperkalaemia; a child with hyperkalaemia needs urgent hospital assessment.

Dose source

Hyperkalemia - StatPearls - NCBI Bookshelf (NBK470284) - disease-level clinical article

Why

Loop diuretic that promotes renal potassium excretion, added alongside potassium-binding therapy in a volume-overloaded patient with preserved renal function; it does not replace urgent hospital referral if potassium is severely elevated or ECG changes are present.

Cautions
  • These agents may be administered in nonoliguric, volume-overloaded patients but should not be used as monotherapy in symptomatic hyperkalemia.
  • Severe hyperkalaemia (>6.5 mmol/L or ECG changes) requires urgent hospital referral.
  • In euvolaemia or hypovolaemia with preserved renal function, isotonic saline is given as needed before the 40 mg intravenous dose.
  • Monitor blood pressure and renal function.
Egyptian brands
Egyptian brandManufacturerIndicative price
FUROSEMIDE 40MG/4ML 3 AMP.SEDICO6.50 EGP
LASIPHAR 40MG/4ML I.M./I.V. 3 AMPS.EIMC > PHAROPHARMA6.50 EGP
DIUSEX 40MG/4ML 5 AMP.GLOBAL NAPI PHARMACEUTICALS > AL DELTA PHARMACEUTICALS TRADING CO.13.50 EGP
LAFUREX 40MG/4ML 3 AMP.AMOUN13.50 EGP
FUROSEMIDE-ALEX 40MG 5 I.M. I.V. AMP.ALEXANDRIA50.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.