From the Guidelines
To treat a potassium level of 7.1 mmol/L, immediate medical attention is required, and treatment should begin with IV calcium gluconate to stabilize cardiac membranes and protect the heart, as recommended by the most recent study 1. The management of acute hyperkalemia depends on the magnitude or severity of the increase in K+ concentration, especially when combined with marked electrocardiographic (ECG) changes and severe muscle weakness 1.
Treatment Options
- IV calcium gluconate administration rapidly reduces the membrane excitatory effects of K+ on cardiac tissue within 1 to 3 minutes, thereby minimizing the potential for cardiac arrhythmia 1
- Insulin and glucose administration, as well as inhaled β-agonists, act within 30 minutes to promote redistribution of serum K+ into the intracellular space, but do not change total body K+ levels 1
- Sodium bicarbonate may be used to promote K+ excretion in patients with concurrent metabolic acidosis 1
- Hemodialysis increases K+ elimination from the body and may be used as an adjunctive therapy in acute hyperkalemia after instituting other approaches 1
Key Considerations
- The underlying cause of hyperkalemia must be identified and addressed, which may include medication review, treatment of renal failure, or correction of metabolic acidosis 1
- Continuous cardiac monitoring is essential throughout treatment as hyperkalemia can cause life-threatening arrhythmias 1
- Loop diuretics like furosemide increase potassium excretion in patients with adequate kidney function, and potassium binders such as sodium polystyrene sulfonate or patiromer can be used to manage hyperkalemia 1
From the FDA Drug Label
Sodium Polystyrene Sulfonate Powder, for Suspension is indicated for the treatment of hyperkalemia (1). The average total daily adult dose of Sodium Polystyrene Sulfonate Powder, for Suspension is 15 g to 60 g, administered as a 15-g dose (four level teaspoons), one to four times daily (2.1).
To treat potassium 7.1, Sodium Polystyrene Sulfonate Powder, for Suspension can be used. The recommended dose is 15 g to 60 g per day, administered as a 15-g dose, one to four times daily 2.
- Key considerations:
- This medication should not be used as an emergency treatment for life-threatening hyperkalemia due to its delayed onset of action.
- Patients should be monitored for signs of fluid overload, especially those sensitive to high sodium intake.
- Other orally administered drugs should be taken at least 3 hours before or 3 hours after Sodium Polystyrene Sulfonate Powder, for Suspension.
From the Research
Treatment Options for Hyperkalemia
- The treatment for hyperkalemia typically involves measures to stabilize cardiac membranes, shift potassium from the extracellular to the intracellular compartment, and promote potassium excretion 3, 4, 5, 6.
- Calcium gluconate 10% can be administered intravenously to stabilize cardiac membranes, unless the patient is in cardiac arrest, in which case calcium chloride is recommended 4.
- Insulin, usually with concomitant glucose, and albuterol are preferred to lower serum potassium levels in the acute setting 3, 4, 7.
- Sodium polystyrene sulfonate is reserved for subacute treatment, but its efficacy is debated 3, 4, 5, 6.
- Dialysis is the most efficient means to enable removal of excess potassium, and loop and thiazide diuretics can also be useful 4.
- New medications, such as patiromer and sodium zirconium cyclosilicate, have shown promise in promoting gastrointestinal potassium excretion 4, 5.
Specific Treatment Approaches
- For patients with severe or symptomatic hyperkalemia, urgent treatment is necessary, and may include intravenous calcium, insulin, and glucose, as well as nebulized albuterol 3, 4.
- In patients with cardiac dysrhythmias, calcium gluconate or calcium chloride should be administered promptly to stabilize cardiac membranes 4, 6.
- For patients with hyperkalemia due to renal failure, dialysis may be necessary to remove excess potassium 4, 6.
- In patients with hyperkalemia due to medication use, discontinuation of the offending medication and treatment with insulin, glucose, and albuterol may be effective 3, 5.