Hyperkalemia Treatment (E.A.T. D.I.C.K.)

The mnemonic

For severe hyperkalemia (elevated serum potassium), a nursing student asked what to do for a potassium of 7.1 mEq/L. The answer, as a memory aid: E.A.T. D.I.C.K.

E

EKG — get a 12-lead / continuous cardiac monitoring immediately. Hyperkalemia is a cardiac emergency; ECG changes (peaked T waves, widened QRS, flattened P waves, eventual sine wave pattern) drive urgency and treatment sequencing.

A

Albuterol — nebulized beta-2 agonist. Shifts potassium intracellularly (temporary, does not remove potassium from the body).

T

Telemetry — continuous cardiac monitoring throughout treatment; hyperkalemia can cause fatal dysrhythmias with little warning.

D

Dextrose — given with insulin (see next letter) to prevent hypoglycemia while insulin drives potassium into cells.

I

Insulin — IV regular insulin is one of the fastest ways to shift potassium intracellularly; always given with dextrose unless the patient is already hyperglycemic.

C

Calcium (gluconate or chloride) — does not lower serum potassium. It stabilizes the cardiac cell membrane and is given first, before the potassium-lowering measures, when ECG changes are present, to protect the heart while the other interventions take effect.

K

Kayexelate (sodium polystyrene sulfonate) or Lokelma (patiromer/sodium zirconium cyclosilicate) — these are the interventions that actually remove potassium from the body (via the GI tract), rather than just shifting it intracellularly. Slower onset than the measures above. Dialysis is the definitive treatment for severe or refractory cases.

Why the sequence matters

Notice the mnemonic is not strictly in clinical priority order — in practice, if ECG changes are present, IV calcium is given first to stabilize the myocardium, then the potassium-shifting measures (insulin/dextrose, albuterol) are given rapidly, and finally the potassium-removing measures (Kayexelate/Lokelma, dialysis) address the underlying total-body potassium load. The letters spell something memorable; the actual bedside order is calcium → shift → remove, all while on continuous cardiac monitoring.

Question

A client's potassium level returns at 7.1 mEq/L and the ECG shows peaked T waves and a widening QRS. Which intervention should the nurse anticipate first?

1. Sodium polystyrene sulfonate (Kayexelate) orally
2. IV calcium gluconate
3. Nebulized albuterol
4. Hemodialysis

Answer: 2 (IV calcium gluconate)

Rationale: With ECG changes present, cardiac membrane stabilization is the immediate priority — calcium does not lower the potassium level but protects the heart from lethal dysrhythmias while potassium-shifting and potassium-removing therapies are initiated. Kayexelate and dialysis remove potassium but act too slowly to be first-line in an unstable rhythm; albuterol shifts potassium but does not protect the myocardium the way calcium does.

References

Kraft, M. D., Btaiche, I. F., Sacks, G. S., & Kudsk, K. A. (2005). Treatment of electrolyte disorders in adult patients in the intensive care unit. American Journal of Health-System Pharmacy, 62(16), 1663-1682.

Rossignol, P., Legrand, M., Kosiborod, M., Hollenberg, S. M., Peacock, W. F., Emmett, M., Epstein, M., Kovesdy, C. P., Yilmaz, M. B., Stough, W. G., Gayat, E., Pitt, B., Zannad, F., & Mebazaa, A. (2016). Emergency management of severe hyperkalemia: Guideline for best practice and opportunities for the future. Pharmacological Research, 113, 585-591.

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