From the Guidelines
Hyperkalemia protocols should be initiated immediately after confirming elevated potassium levels on a BMP (Basic Metabolic Panel). For mild hyperkalemia (K+ 5.0-5.9 mEq/L), recheck potassium within 1-2 hours after initial interventions. For moderate hyperkalemia (K+ 6.0-6.9 mEq/L), recheck within 1 hour. For severe hyperkalemia (K+ ≥7.0 mEq/L), treat as a medical emergency and recheck potassium within 30 minutes after initial interventions.
Treatment Options
Treatment typically includes:
- Calcium gluconate 1g IV over 2-3 minutes for cardiac membrane stabilization in severe cases
- Insulin 10 units IV with 25g dextrose to shift potassium intracellularly
- Sodium bicarbonate 50 mEq IV if acidotic
- Sodium polystyrene sulfonate (Kayexalate) 15-30g orally or rectally to remove potassium from the body
- Loop diuretics like furosemide 40-80mg IV may be used in patients with adequate renal function
Monitoring
Continuous cardiac monitoring is essential during treatment, especially in severe cases, as hyperkalemia can cause life-threatening arrhythmias. The urgency of treatment is based on both the absolute potassium level and the presence of ECG changes, which indicate cardiac effects of hyperkalemia 1.
Key Considerations
The management of hyperkalemia should be individualized, taking into account the patient's underlying medical conditions, such as chronic kidney disease, diabetes, and heart failure, as well as their medication regimen, including renin-angiotensin-aldosterone system inhibitors (RAASi) therapy 1.
From the FDA Drug Label
The intensity and duration of therapy depend upon the severity and resistance of hyperkalemia. The FDA drug label does not answer the question.
From the Research
Hyperkalemia Protocol
- Hyperkalemia is a condition where serum potassium levels exceed 5.5 mmol/l, and it can lead to fatal dysrhythmias and muscular dysfunction 2.
- The treatment of hyperkalemia involves stabilizing the cardiac membrane, shifting potassium into cells, and decreasing total body potassium content 3.
- Acute hyperkalemia requires immediate attention, while chronic hyperkalemia develops over a longer period and has less severe manifestations 3.
Timing of Hyperkalemia Protocol
- There is no specific evidence on how soon after checking BMP (Basic Metabolic Panel) the hyperkalemia protocol should be initiated.
- However, it is essential to monitor potassium levels closely, especially in high-risk patients, as hyperkalemia can lead to adverse outcomes 4.
Treatment Options
- Treatment options for hyperkalemia include glucose and insulin, bicarbonate, calcium gluconate, beta-2 agonists, hyperventilation, and dialysis 2.
- New anti-hyperkalemic agents, such as patiromer and zirconium cyclosilicate, have shown effectiveness in treating hyperkalemia and may allow for less restrictive potassium diets and lower discontinuation rates of renin-angiotensin-aldosterone system inhibitors (RAASis) 4.
- Potassium-binding medications, such as sodium polystyrene sulfonate (SPS) and sodium zirconium cyclosilicate (SZC), can also aid in reducing serum potassium levels 2, 5.