From the Guidelines
Hyperkalemia should be treated immediately with calcium gluconate 10% (10 mL IV over 2-3 minutes) to stabilize cardiac membranes, followed by insulin (10 units regular insulin IV) with glucose (25g dextrose) to shift potassium intracellularly, as recommended by the most recent and highest quality study [ 1 ].
Acute Management of Hyperkalemia
The goal of acute management is to rapidly lower serum potassium levels and prevent cardiac arrhythmias. The following treatments can be used:
- Calcium gluconate 10% (10 mL IV over 2-3 minutes) to stabilize cardiac membranes
- Insulin (10 units regular insulin IV) with glucose (25g dextrose) to shift potassium intracellularly
- Albuterol nebulization (10-20 mg) to help lower potassium levels
- Sodium polystyrene sulfonate (15-30g orally or rectally), patiromer (8.4-16.8g daily), or sodium zirconium cyclosilicate (10g three times daily initially) for potassium removal
Chronic Management of Hyperkalemia
For chronic management, addressing underlying causes is essential, including:
- Adjusting medications like ACE inhibitors, ARBs, or potassium-sparing diuretics
- Treating acidosis
- Managing renal dysfunction
- Dietary potassium restriction (<2-3g daily)
Importance of Monitoring
Regular monitoring of potassium levels is crucial to prevent hyperkalemia, especially in patients with cardiovascular disease or renal impairment [ 1 ].
Treatment Options
Treatment options for hyperkalemia include:
- Loop diuretics to increase renal potassium excretion
- Hemodialysis to remove potassium from the blood
- Cation-exchange resins to enhance fecal potassium excretion
- New potassium binders, such as patiromer and sodium zirconium cyclosilicate, to increase fecal potassium excretion [ 1 ].
Conclusion is not allowed, so the answer will be ended here.
From the FDA Drug Label
1 INDICATIONS AND USAGE Sodium Polystyrene Sulfonate Powder, for Suspension is indicated for the treatment of hyperkalemia.
Limitation of Use: Sodium Polystyrene Sulfonate Powder, for Suspension should not be used as an emergency treatment for life-threatening hyperkalemia because of its delayed onset of action [see Clinical Pharmacology (12.2)].
Hyperkalemia Treatment: Sodium Polystyrene Sulfonate Powder, for Suspension is indicated for the treatment of hyperkalemia. However, it should not be used as an emergency treatment for life-threatening hyperkalemia due to its delayed onset of action 2.
- The average total daily adult dose is 15 g to 60 g, administered as a 15-g dose, one to four times daily 2.
- It is essential to monitor serum potassium during therapy because severe hypokalemia may occur 2.
From the Research
Definition and Causes of Hyperkalemia
- Hyperkalemia is defined as a condition where a serum potassium level is >5.5 mmol/l 3
- It is associated with fatal dysrhythmias and muscular dysfunction 3
- Certain medical conditions, such as chronic kidney disease (CKD), diabetes mellitus, and others, can lead to hyperkalemia 3, 4
- Reduced potassium excretion is typically associated with decreased potassium secretion in the aldosterone-sensitive distal nephron of the kidney 5
Symptoms and Diagnosis of Hyperkalemia
- Many of the signs of hyperkalemia are nonspecific 3
- A history and physical examination can be beneficial in the diagnosis of the condition 3
- Certain characteristic electrocardiogram findings are associated with hyperkalemia along with laboratory potassium levels 5, 3
Treatment of Hyperkalemia
- Treatment of life-threatening hyperkalemia involves administration of intravenous calcium salts to stabilise the resting cardiac membrane potential 5
- The potassium concentration can be lowered by administration of intravenous insulin combined with an infusion of glucose to stimulate intracellular uptake of potassium 5, 6
- Nebulised β-2 adrenoceptor agonists can augment the effects of intravenous insulin and glucose pending more definitive management of the recurrent hyperkalemia risk 5, 6
- Additional management steps include stopping further potassium intake and careful review of prescribed drugs that may be adversely affecting potassium homeostasis 5
- Hemodialysis should be considered in the course of CPR in severe hyperkalemia induced cardiac arrest if conventional therapies fail 7
Management and Prevention of Hyperkalemia
- Changes to prescribing systems and an agreed institutional protocol for management of hyperkalemia can improve patient safety for this frequently encountered electrolyte disorder 5
- Long-term plan to prevent recurrence or worsening of hyperkalemia includes elucidating underlying causes and pathophysiologic mechanisms, and searching for medications that may have led to the development of hyperkalemia 6
- New acute, chronic, and preventative oral therapies, such as patiromer calcium, cross-linked polyelectrolyte, and ZS-9, can potentially create a greater margin of safety for vulnerable patients with combined heart and kidney disease 4