Eight results that catch dangerous potassium, sodium and glucose, and show how the kidneys are doing at the bedside.
Tests in Panel
8
Critical K⁺ (mEq/L)
≥6.5 or <2.5
Specimen
Gold/Green
At a Glance
Why It's Ordered
To answer ED, ICU and transport questions about electrolyte disturbance, kidney injury, glucose derangement and calcium in patients with altered mental status, weakness, arrhythmia, vomiting, diuretic use or medication toxicity.
Check First
K⁺, glucose, creatinine and HCO₃⁻ with the anion gap: the values that change management in minutes.
Critical Values
K⁺ <2.5 or ≥6.5 mEq/L · Na⁺ <120 or >160 mEq/L · Glucose <40 or >450 mg/dL · Total Ca <6.0 or >13.0 mg/dL
Don't Miss
A hemolyzed or fist-clenched sample gives pseudohyperkalemia. Repeat on a clean draw, but treat now if the ECG shows peaked T waves, PR prolongation or QRS widening.
Field & Transport
i-STAT CHEM8+ gives electrolytes, ionized calcium, glucose, BUN and creatinine in minutes, but no total calcium or liver tests. Glucometers read falsely in shock. Send the lab BMP and repeat K⁺ and glucose after any treatment en route.
Panel Overview
The Basic Metabolic Panel (BMP) measures eight analytes: glucose, calcium, sodium, potassium, chloride, total CO₂, BUN and creatinine. Anion gap, eGFR and BUN:Cr are calculated from these results and are not counted as components. The BMP is the most common chemistry panel at ED triage, on ICU morning labs and before transfer. Chem-7 is an older name for a seven-analyte version of the same core chemistry. Check whether your laboratory's panel includes calcium.
The Renal Panel adds phosphorus and albumin to the BMP, and the Comprehensive Metabolic Panel (CMP) adds albumin, total protein and the liver tests to it. Because the BMP has no albumin, it cannot correct calcium.
When to Order:
Sepsis or shock: baseline kidney function, electrolytes and acid-base status
Altered mental status or seizure: sodium, glucose and calcium as first-line causes
Weakness, palpitations or arrhythmia: potassium, calcium and kidney function
Diabetic ketoacidosis or hyperosmolar state: glucose, CO₂, anion gap and creatinine
Vomiting, diuretic use or overdose: electrolytes and kidney function before medication decisions
Pre-procedure or pre-transfer: baseline kidney function, potassium and glucose
Electrolytes
Sodium (Na⁺)
Normal: 135–145 mEq/L
Main extracellular cation that sets serum osmolality. Low values come from water excess, SIADH or diuretics; high values from water loss or hypertonic intake.
Serum bicarbonate plus dissolved CO₂. Low values indicate metabolic acidosis or compensated respiratory alkalosis; high values suggest contraction or vomiting.
Urea from protein catabolism. Rises with volume depletion, GI bleeding, high-protein intake and steroids as well as kidney injury; interpret with creatinine.
Main energy substrate and the first value to check in any altered patient. Low values need treatment before other causes are considered; high values need ketones and osmolality.
Estimated GFR from creatinine, age and sex using the race-free CKD-EPI 2021 equation. Less accurate in acute kidney injury, where the value is not at steady state.
BMP components: adult reference intervals and typical critical values
Test
Adult Normal (conventional)
SI Units
Critical Low
Critical High
Notes
Sodium
135–145 mEq/L
135–145 mmol/L
<120
>160
Serum osmolality-linked
Potassium
3.5–5.0 mEq/L
3.5–5.0 mmol/L
<2.5
≥6.5
Hemolysis-prone
Chloride
98–106 mEq/L
98–106 mmol/L
—
—
Interpret with Na⁺ and CO₂
Total CO₂
22–29 mEq/L
22–29 mmol/L
<10
>40
Arterial HCO₃⁻ is 22–26
BUN
7–20 mg/dL
2.5–7.1 mmol/L (urea)
—
—
Age- and protein-dependent
Creatinine
M 0.7–1.3 | F 0.6–1.1 mg/dL
M 62–115 | F 53–97 µmol/L
—
—
Sex-specific; lab-dependent
Glucose
70–99 mg/dL (fasting)
3.9–5.5 mmol/L
<40
>450
Fasting interval
Total Calcium
8.5–10.5 mg/dL
2.12–2.62 mmol/L
<6.0
>13.0
Albumin-dependent; no albumin on BMP
Lab Variation: Your lab's intervals are the ones that count. Intervals and critical lists shift by laboratory, analyzer and assay. Work from the interval your lab reports and its critical-call policy.
Systematic Interpretation
Sodium and osmolality: Na⁺ names the problem: hyponatremia or hypernatremia. Calculate serum osmolality as 2 × Na⁺ + glucose/18 + BUN/2.8 (normal 275–295 mOsm/kg). Correct the sodium for glucose: add about 1.6 to 2.4 mEq/L for every 100 mg/dL above 100.
Potassium with the ECG: Read the tracing with the number. K⁺ of 6.5 mEq/L or higher is an emergency, and so is any hyperkalemic ECG change, however it was measured. Moderate K⁺ of 6.0–6.4 mEq/L with ECG changes gets the same treatment. A mild rise? Check for hemolysis before you act on it.
Bicarbonate and anion gap: The gap is Na⁺ − (Cl⁻ + total CO₂), normal 4–12 mEq/L depending on the analyzer, and it leaves potassium out. A high gap with low CO₂ means high-anion-gap metabolic acidosis. A normal gap with low CO₂ points to a non-gap cause.
BUN, creatinine and eGFR: Judge creatinine against baseline. KDIGO AKI means a rise of 0.3 mg/dL within 48 hours, or 1.5 times baseline within 7 days. BUN:Cr helps you separate prerenal causes from intrinsic ones.
Glucose: Low glucose gets treated before anything else. High glucose sends you to the anion gap, ketones and osmolality, which is how you find a hyperosmolar state.
Calcium: A BMP cannot correct total calcium, because it has no albumin. Get albumin from another panel. If albumin is unknown, the patient is critically ill, or blood has been transfused, measure ionized calcium instead.
Anion gap
Na⁺ − (Cl⁻ + total CO₂); normal 4–12 mEq/L
Corrected sodium (glucose)
Na⁺ + 1.6 × [(glucose − 100) ÷ 100]
Corrected calcium (needs albumin from another panel)
Ca + 0.8 × (4.0 − albumin)
Worked Example: Na⁺ 130, Cl⁻ 96, total CO₂ 16, glucose 320 mg/dL, BUN 40, creatinine 2.4 mg/dL, total Ca 8.0 mg/dL. The gap is 130 − (96 + 16) = 18, which is high. Correct the sodium: 130 + 1.6 × 2.2 = 133.5 mEq/L. Glucose explains part of the low sodium. The corrected 133.5 mEq/L is still mildly low, so a hypotonic component is still there. BUN:Cr is 40 ÷ 2.4 = 16.7, which sits in the middle. Total Ca 8.0 mg/dL can't be read on the BMP alone. Order albumin or ionized calcium before you treat.
Patterns & Differential
Every pattern here is a combination of BMP results, not a single value. Check the clinical picture, then run the next test on the list.
Exclude hypothyroidism and adrenal insufficiency first
Hypercalcemia
Total Ca above 10.5 mg/dL, with albumin needed to correct it
Hyperparathyroidism, malignancy, thiazides, vitamin D excess
Albumin, ionized calcium, PTH, medication review
Pseudohyperkalemia
K⁺ above 5.0 mEq/L with no ECG change, hemolyzed or fist-clenched sample
Hemolysis, prolonged tourniquet, delayed processing, high platelet or WBC counts
Repeat on a clean draw with a short tourniquet time
Serial Testing & Kinetics
Analyte
Changes After
Peak or Nadir
Repeat Interval
Monitoring Target
Potassium
Insulin-glucose, beta-agonist or potassium-binder treatment
Early effect, then rebound
At least 1, 2, 4, 6 and 24 hr after identifying and treating moderate or severe hyperkalemia (UK guideline 2026)
Falling K⁺ with no ECG change
Glucose
Insulin-glucose infusion
Falls within the first hour; late hypoglycemia possible
0, 30, 60, 90, 120, 180, 240, 300 and 360 min after insulin-glucose (UK guideline 2026)
Glucose kept above 70 mg/dL
Sodium
Hypertonic saline bolus
Rises after each bolus
After each bolus, then per the hypertonic saline page schedule
Rise kept within the 24-hour limits (see Critical Findings)
Creatinine
Kidney injury
Rises over 24–48 hr
Repeat daily until the trend is clear
Stable or falling creatinine
Critical Findings & Emergency Actions
Figure 1: Peaked T waves on a 12-lead ECG from a patient with kidney disease and K⁺ 8.2 mmol/L. Treat the ECG finding, not only the number. Source: Wikimedia Commons, Michael-Joseph F. Agbayani and Eddieson Gonzales, CC BY 4.0
Hyperkalemia with ECG changes or K⁺ at or above 6.5 mEq/L
Recognize: peaked T waves, PR prolongation, lost P waves, QRS widening, bradycardia or sine wave. The ECG changes get treated now. Nobody waits for a second level. Follow local protocols and medical direction.
Protect the heart (Paramedic/RN/CCT): calcium chloride 10%, 1 g (10 mL) IV over 5 min, or calcium gluconate 10%, 30 mL IV over 10 min (UK guideline 2026). Use chloride in cardiac arrest or peri-arrest, and gluconate for everyone else with ECG changes. A central or large vein is the better route where you can get one. Differs from FDA label: the US label caps calcium chloride at no faster than 1 mL/min, so this 5-minute push is off-label (UK guideline 2026; see the calcium chloride page). Keep repeating while ECG changes stay.
Shift K⁺ into cells:High-alert regular insulin 10 units IV with dextrose 25 g (UK guideline 2026). Some US protocols use 5 units, especially in kidney failure, where insulin clears more slowly (see the insulin page). Low glucose can last up to 6 hours, so keep rechecking it for that long.
Prevent hypoglycemia: if pre-treatment glucose is below 126 mg/dL (7.0 mmol/L), infuse 10% glucose at 50 mL/hr for 5 hr (25 g) (UK guideline 2026).
Adjunct: nebulized albuterol 10–20 mg for severe hyperkalemia (UK guideline 2026). Albuterol supports the treatment and never stands alone. High doses drive heart rate up and can set off ischemia or arrhythmia.
Remove K⁺ and recheck: potassium binder or dialysis per protocol. Severe hyperkalemia on dialysis means urgent dialysis (UK guideline 2026). Check K⁺ at 1, 2, 4, 6 and 24 hr. Rebound is common, so do not skip a check.
IV sodium bicarbonate has no routine role for acute hyperkalemia outside cardiac arrest (UK guideline 2026). Calcium protects the myocardium. It won't lower K⁺. With ECG changes, moderate hyperkalemia (K⁺ 6.0–6.4 mEq/L) gets the same calcium. If ECG changes are absent, the UK guideline reaches for insulin-glucose and nebulized albuterol. US practice varies on several doses, so go by local protocol and medical direction.
If the arrest is suspected to be hyperkalemic, the ACLS arrest algorithm still runs. Calcium chloride 10 mL (1 g) of 10% goes in IV or IO as a push. Sodium bicarbonate is 50 mEq IV or IO, repeated every 5–10 min as the blood gas guides (UK guideline 2026, 25.1–25.3; US label). Regular insulin is 10 units IV over 15–30 min with dextrose 50 g (AHA 2025 Table 3). IV calcium is COR 2b, LOE C-LD. IV sodium bicarbonate is COR 2b, LOE C-EO. IV insulin with glucose is COR 2b, LOE C-EO. AHA's 2025 CPR and ECC guidance, Part 10, calls all three effectiveness not well established in this setting. The UK guideline 2026 and ERC pair insulin with dextrose 25 g. Inhaled beta-2 agonists earn a no-benefit grade in arrest (COR 3: No Benefit, LOE C-EO; recommendation 4).
On digoxin? Give IV calcium slowly, with close ECG monitoring (calcium chloride and calcium gluconate labels).
Severe symptomatic hyponatremia (seizure, coma or respiratory distress)
Recognize: hypotonic hyponatremia with neurologic symptoms. Treat it now, acute or chronic. A pending sodium result is never a reason to delay.
Airway and perfusion (Paramedic/RN/CCT): protect the airway, check glucose and give oxygen as needed.
High-alert 3% NaCl:High-alert 100–150 mL IV over 10–20 min. The US expert panel gives 100 mL over 10 min. Europe's guideline uses 150 mL over 20 min. Repeat per protocol until symptoms ease or Na⁺ rises 4–6 mEq/L.
Recheck sodium after each bolus. The European guideline (2014) caps the rise at 10 mEq/L in the first 24 hr, then 8 mEq/L per 24 hr. The US expert panel (2013) allows 10–12 mEq/L in 24 hr and 18 mEq/L in 48 hr. It drops to 8 mEq/L in any 24 hr when osmotic demyelination risk is high: hypokalemia, alcohol use disorder, malnutrition, advanced liver disease. When they disagree, use the tighter of the two.
Do not free-flow hypertonic saline: give it as a timed bolus or per a pump protocol.
If the limit is exceeded or Na⁺ overcorrects: stop hypertonic saline and call medical direction for the next step.
Hypoglycemia (glucose below 70 mg/dL with symptoms)
Recognize: sweating, confusion, seizure or unresponsiveness. Every altered patient gets a glucose check before other causes come into play.
Alert and able to swallow: oral fast-acting carbohydrate per local protocol, then recheck glucose.
Cannot swallow safely (Paramedic/RN/CCT): dextrose 10 g IV (100 mL of D10), given in 5 g steps with a glucose recheck after each step until alert. Field maximum 25 g per dosing episode, then per medical direction (see the dextrose page).
No IV or IO access: glucagon 1 mg IM or subcutaneous, per the glucagon page and protocol.
Sulfonylurea or long-acting insulin: the low comes back. Keep watching for several hours after treatment.
Symptomatic hypocalcemia (tetany, seizure, QT prolongation or hypotension)
Recognize: carpopedal spasm, laryngospasm, seizure, QT prolongation or hypotension. Get an ionized calcium. Total calcium on a BMP can't be corrected without albumin. The goal is ionized calcium back in the reference range (4.5–5.3 mg/dL) and symptoms gone.
Calcium gluconate 10% (Paramedic/RN): the go-to when you only have a peripheral vein. Adult dose 1–2 g (10–20 mL) IV, no faster than 200 mg/min. Repeat as ionized calcium and symptoms guide. Use a secure line. Tissue necrosis is the risk to avoid (DailyMed label).
Calcium chloride 10% (Paramedic/RN): usual adult dose 200 mg to 1 g (2–10 mL) IV, given slowly and no faster than 1 mL/min, preferably into a central or deep vein. Each mL carries about three times the elemental calcium of gluconate, and infiltration does more harm. Let ionized calcium and symptoms set any repeat dose. The label notes rapid excretion (DailyMed label).
Treat hypomagnesemia if it is present. Low magnesium keeps hypocalcemia from fully correcting.
Massive transfusion (ICU/CCT): check ionized calcium with blood gases and treat per the transfusion protocol.
Severe hypercalcemia or severe metabolic acidosis
Recognize: total Ca above 13.0 mg/dL with confusion, vomiting or polyuria. Or low CO₂ with a high anion gap and a low pH on blood gas.
Hypercalcemia (RN/CCT): isotonic saline per protocol; hold thiazides and other calcium-raising drugs; transfer for definitive treatment.
Acidosis (ICU): treat the cause first (insulin and fluids in DKA, perfusion in shock, toxic ingestion). Bicarbonate is a protocol call. Outside arrest, it isn't routine for hyperkalemia (UK guideline 2026).
Severe hypokalemia (K⁺ below 2.5 mEq/L)
Recognize: weakness, paralysis, arrhythmia, or ECG changes such as flattened T waves, U waves or ST depression. Manage it under local protocol and medical direction.
Monitor (ICU/CCT): continuous ECG monitoring; check and replace magnesium.
Replace potassium (ICU): give oral potassium when the patient can swallow safely. IV potassium chloride runs through a pump at a controlled rate per protocol. The label says rates should not usually exceed 10 mEq/hour. Up to 40 mEq/hour is for serum K⁺ under 2 mEq/L with ECG changes or paralysis, and only on continuous ECG monitoring. High-alert concentrated potassium is never an IV push. Peripheral and central limits and concentrations vary by policy. Recheck the level and the ECG as you replace.
Hyperglycemic crisis: suspected DKA or HHS
Recognize: DKA means ketosis with a pH below 7.30 or bicarbonate below 18 mmol/L, with glucose at 200 mg/dL or higher, or a known diabetes history (2024 ADA consensus). Glucose can sit near normal in euglycemic DKA, most often with SGLT2 inhibitors. HHS brings markedly high glucose, dehydration and altered mental status, with little or no ketosis. The BMP gives you the glucose, CO₂, anion gap and potassium. Ketones, blood gas and serum osmolality confirm it (2024 ADA consensus).
Fluids first (ICU/CCT): start intravenous fluid replacement per protocol. In both DKA and HHS, fluid does most of the work.
Check potassium before insulin: the body runs short of potassium even when the serum level reads normal or high. If K⁺ sits under 3.5 mEq/L, begin replacement at up to 10 mEq/hour and hold insulin until K⁺ climbs above 3.5 mEq/L.
Insulin per protocol once K⁺ is at least 3.5 mEq/L. Recheck K⁺ 2 hours after insulin starts and every 4 hours until the crisis resolves.
Monitor and transfer to a critical care setting per medical direction (ADA Standards of Care 2026, Section 6).
Severe hypernatremia (Na⁺ above 160 mEq/L)
Recognize: thirst, confusion, weakness, seizure or coma, usually from water loss. Check volume status and glucose. The sodium result alone won't tell you the cause.
Airway, perfusion and seizure care (Paramedic/RN/CCT): protect the airway and treat hypotension and seizure per protocol.
Estimate the free-water deficit (adult): 0.6 × weight (kg) × (Na⁺ ÷ 140 − 1), using 0.5 instead of 0.6 for women and older adults (2000 NEJM review).
Correct slowly: Pull Na⁺ down too fast and the brain swells (cerebral edema). Replace water by mouth or with hypotonic IV fluid per protocol, and set the limit on the fall in Na⁺ with medical direction.
Recheck sodium at intervals set by protocol and transfer for ongoing correction.
Pitfall: insulin without dextrose, or no repeat glucose check, sets up late hypoglycemia. The risky hours come after treatment. Keep rechecking glucose through them, per local protocol.
Prehospital & Transport Considerations
Point-of-Care Testing
Device / Method
Analytes
Specimen
Limitations
i-STAT CHEM8+
Na⁺, K⁺, Cl⁻, ionized Ca, glucose, BUN, creatinine, TCO₂
Whole blood, heparinized
No total calcium and no liver tests; eGFR reporting depends on analyzer configuration; cartridge temperature and storage limits
Glucometer
Glucose only
Capillary blood
Unreliable in shock or hypoperfusion; interference from maltose, icodextrin and high-dose vitamin C
Laboratory BMP
All 8 analytes
Serum or lithium heparin plasma
Turnaround of hours; results are often not back before transfer, so send the draw and the time
Interfacility Transfer & Handoff
Send the results and the times they were drawn, with any pending BMP components and the creatinine trend.
Record active treatment: insulin or dextrose infusions, calcium doses and times, and any hypertonic saline volume with the time of the next sodium check.
Repeat K⁺ and glucose on arrival and after any treatment en route, per the timing above.
Specimen handling: Keep unspun whole blood at room temperature. Do not chill it for potassium: cold raises K⁺ (pseudohyperkalemia) and slows glucose loss only marginally. Deliver it promptly, or centrifuge and separate. A gray-top fluoride tube is the glucose-preserving option. Follow the receiving laboratory's transport rules, plus the air-transport pressure and temperature rules.
Scope Notes
EMS: point-of-care glucose, and i-STAT electrolytes where stocked. Calcium and insulin depend on the system. Where they are not carried, treat hyperkalemia by early transfer per protocol.
Transport (CCT): The transport team runs the infusions and the monitoring schedule. Confirm which values were drawn before you leave.
ED/ICU: The BMP is the first chemistry most acute decisions lean on. It has no albumin and no liver tests.
Special Populations
Pediatrics
Pediatric reference intervals shift with age for several BMP analytes. This page has no age-band tables, so use your lab's pediatric table. Weight-based doses are below (see weight-based dosing and pediatric vital signs).
Indication
Pediatric Dose
Max / Repeat
Notes
Symptomatic hypocalcemia
Calcium chloride 10%: 2.7–5 mg/kg IV slowly (0.027–0.05 mL/kg of 10%)
Repeat as ionized calcium guides; label cites no trial data on repeat dosing
NASEMSO v3.0, Cardiac Arrest item 8b (p. 119). Differs from FDA label: the label gives no hyperkalemia dose; the pediatric label dose is for hypocalcemia only.
Hyperkalemic arrest (insulin)
Regular insulin 0.1 units/kg IV over 15–30 min with dextrose 0.5 g/kg (D10 5 mL/kg IV)
Max 10 units (severe hyperkalemia)
AHA 2025 Part 10, Table 3 (children, arrest). No pediatric insulin dose is established here for non-arrest hyperkalemia; use the pediatric protocol and medical direction.
Max 100 mL per dose; repeat per protocol and recheck Na⁺ after each dose
High-alert never free-flow (hypertonic saline page)
The hypocalcemia row is the labeled pediatric range. That label covers only hypocalcemic disorders. So the hyperkalemia calcium row (20 mg/kg) is off-label, and its source is NASEMSO v3.0 (Cardiac Arrest, item 8b).
Pregnancy
Pregnancy changes how you read the panel. Respiratory alkalosis is normal here, with PaCO₂ around 28–32 mmHg and HCO₃⁻ around 18–21 mEq/L. A low total CO₂ alone does not mean metabolic acidosis. Dilution lowers sodium. A creatinine above 0.8 mg/dL is abnormal in pregnancy. Treat hyperkalemia and hypoglycemia the way you would in a non-pregnant adult.
Older Adults
A normal creatinine can mask a markedly reduced GFR when muscle mass is low. Use eGFR instead. In this group, the usual culprits behind hyperkalemia, hyponatremia and AKI are volume depletion and polypharmacy (diuretics, ACE inhibitors, ARBs, potassium-sparing drugs).
CKD and Dialysis
Read K⁺ and HCO₃⁻ against the dialysis schedule. The pre-dialysis sample is the reference. Severe hyperkalemia in patients on dialysis calls for urgent dialysis (UK guideline 2026). With ECG changes present, give IV calcium even when dialysis is immediately available (UK guideline 2026).
Specimen Collection & Interfering Factors
Specimen and tube: serum (gold or red top) or lithium heparin plasma (green top). Tube colors vary by institution, so follow the lab's requirements.
Handling: Analyze it promptly. Glucose drops in unspun whole blood. Separate the sample fast, or use the lab's glucose-preserving tube when a delay can't be avoided.
Order of draw (CLSI GP41): blood cultures, light blue, red or gold, green, lavender, gray.
Tourniquet and fist: keep tourniquet time short and do not have the patient pump the fist.
Error or Interferent
Effect on Results
Prevention
Hemolysis
Falsely high K⁺ (pseudohyperkalemia)
Clean venipuncture; repeat without hemolysis, and treat now if the ECG shows toxic changes
Drawing above an IV line
Dilution with saline (low K⁺, calcium, glucose, BUN, creatinine; high Na⁺ and Cl⁻); dextrose-containing fluid falsely raises glucose
Draw from the opposite arm; if not possible, stop the infusion and follow lab flushing policy
Prolonged tourniquet or fist clenching
Falsely high K⁺
Limit tourniquet time; no fist pumping
Delayed processing
Glucose falls; K⁺ rises
Process promptly or use the lab's glucose-preserving tube
EDTA (lavender) carryover
Falsely high K⁺ and very low calcium
Follow the order of draw; avoid tube carryover
Lipemia or icterus
Method-dependent interference
Ask the lab for its interference index
Point-of-care meter interference
Falsely high glucose (maltose, icodextrin, vitamin C)
Use a laboratory glucose when the meter result does not fit the patient
Clinical Pearls
Check glucose in every altered patient: Treat low glucose first. Don't wait for the rest of the panel.
Anion gap first, then the cause: Work out the gap before you chase the cause. A raised gap with low CO₂ points toward lactate, ketones, uremia, toxic alcohols or salicylate.
Calcium cannot be corrected on a BMP: The BMP has no albumin, so the number can't be fixed there. In critical illness, order albumin or ionized calcium.
Creatinine lags: It takes 24–48 hours to rise after kidney injury. A normal value doesn't rule out early AKI.
Field and transport: Point-of-care electrolytes are quick. You still need a lab BMP to confirm the trend and the calcium.
Nursing: Calcium goes in IV or IO only, slowly, into a large vein. Never give it IM or subcutaneously. Extravasation causes tissue necrosis.
Critical care: Recheck K⁺ at 1, 2, 4, 6 and 24 hours after treatment. Insulin and beta-agonist effects wear off, so the level can drift back.
Pitfall: Hemolysis makes potassium read falsely high. Redraw, but treat now if the ECG shows toxic changes.
Pitfall: Push the sodium up faster than the limit for that patient's risk, and osmotic demyelination follows. Recheck sodium after every bolus.
American Diabetes Association Professional Practice Committee. 6. Glycemic goals, hypoglycemia, and hyperglycemic crises: Standards of Care in Diabetes—2026. Diabetes Care. 2026;49(suppl 1):S132–S149. https://doi.org/10.2337/dc26-S006
Verbalis JG, Goldsmith SR, Greenberg A, et al. Diagnosis, evaluation, and treatment of hyponatremia: expert panel recommendations. Am J Med. 2013;126(10 suppl 1):S1–S42. https://doi.org/10.1016/j.amjmed.2013.07.006
Spasovski G, Vanholder R, Allolio B, et al. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Nephrol Dial Transplant. 2014;29(suppl 2):i1–i39. https://doi.org/10.1093/ndt/gfu040
Inker LA, Eneanya ND, Coresh J, et al. New creatinine- and cystatin C-based equations to estimate GFR without race. N Engl J Med. 2021;385(19):1737–1749. https://doi.org/10.1056/NEJMoa2102953
Umpierrez GE, Davis GM, ElSayed NA, et al. Hyperglycemic crises in adults with diabetes: a consensus report. Diabetes Care. 2024;47(8):1257–1275. https://doi.org/10.2337/dci24-0032
National Association of State EMS Officials (NASEMSO). National Model EMS Clinical Guidelines, Version 3.0 (March 2022). Cardiac Arrest, item 8b (pediatric calcium chloride dose). https://nasemso.org/docs.ashx?id=1444322
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