Treatment for hyperkalemia

From the Guidelines

Treatment for hyperkalemia typically involves a multi-step approach to rapidly lower potassium levels and prevent cardiac complications.

Key Treatment Steps

• Stop any potassium-sparing medications if the patient is taking them, as these can exacerbate hyperkalemia 1.
• Administer calcium gluconate 1-2 grams intravenously over 2-5 minutes to help stabilize cardiac membranes, especially if there are ECG changes, as it reduces membrane excitation in cardiac tissue within 1 to 3 minutes 1.
• Insulin and glucose therapy: Administer 10 units of regular insulin along with 50 grams of glucose (1 ampule of D50) intravenously to help drive potassium into cells, monitoring blood glucose levels to avoid hypoglycemia, with effects seen within 30 to 60 minutes 1.
• Beta-2 agonist therapy: Consider administering nebulized albuterol (2.5-5 mg) to help decrease potassium levels by promoting cellular uptake, although its effects are short-lived, lasting 2 to 4 hours 1.
• Sodium bicarbonate may be used in patients with metabolic acidosis to promote potassium excretion, but its use is limited to this specific context 1.
• Dialysis: In severe cases of hyperkalemia, especially with significant ECG changes or muscle weakness, consider initiating dialysis to rapidly lower potassium levels, as it increases total potassium elimination from the body 1. It's crucial to monitor the patient's potassium levels closely and adjust treatment as necessary, addressing the underlying cause of hyperkalemia for effective management 1.

From the FDA Drug Label

Sodium polystyrene sulfonate is indicated for the treatment of hyperkalemia. The average total daily adult dose of Sodium Polystyrene Sulfonate is 15 g to 60 g, administered as a 15 g dose (four level teaspoons), one to four times daily.

Treatment for hyperkalemia with sodium polystyrene sulfonate is indicated, with a recommended dosage of 15 g to 60 g per day, administered in divided doses. However, it should not be used as an emergency treatment for life-threatening hyperkalemia due to its delayed onset of action 2.

From the Research

Treatment for Hyperkalemia

• Hyperkalemia is caused by impaired renal excretion, transcellular shifts, or increased potassium intake 3
• Emergent treatment is recommended for patients with clinical signs and symptoms (e.g., muscle weakness, paralysis) or if electrocardiography abnormalities are present 3
• Acute treatment may include:
  • Intravenous calcium
  • Insulin
  • Sodium bicarbonate
  • Diuretics
  • Beta agonists 3, 4
• Dialysis may be considered in the presence of end-stage renal disease, severe renal impairment, or ongoing potassium release 3
• Patiromer and sodium zirconium cyclosilicate are newer potassium binders and may be used in chronic or acute hyperkalemia 3
• Sodium polystyrene sulfonate is associated with serious gastrointestinal adverse effects and should be used with caution 3

Management of Hyperkalemia

• Long-term management of potassium disturbances includes correcting underlying conditions, dietary counseling, and adjusting causative medications 3
• Drug regimens should be reevaluated and, when possible, hypokalemia- or hyperkalemia-causing drugs should be discontinued 4
• Patients with hyperkalemia should be monitored closely for cardiac arrhythmias and muscle symptoms, and treated urgently if these symptoms occur 4
• Falsely elevated potassium levels can occur and should be differentiated from true hyperkalemia to avoid inappropriate treatment 5