From the Guidelines
The treatment for hyperkalemia involves administering intravenous calcium gluconate, insulin/glucose, inhaled β-agonists, intravenous sodium bicarbonate, and hemodialysis, depending on the severity of the condition. For acute hyperkalemia, the management 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
- Intravenous 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.
- Intravenous insulin (plus glucose) and 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.
- Short-term treatment with oral sodium bicarbonate may be used to promote K+ excretion in patients with concurrent metabolic acidosis 1.
- Dialysis 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 symptoms of hyperkalemia can be nonspecific, and although recommended for determining hyperkalemia, ECG findings can be highly variable and not as sensitive as a laboratory test in predicting hyperkalemia or its associated complications 1.
- Several deficiencies associated with current management of acute hyperkalemia were highlighted by the REVEAL-ED study, including a lack of standard, universally accepted treatment protocols or algorithms for managing hyperkalemia 1.
From the FDA Drug Label
Sodium polystyrene sulfonate is a potassium binder indicated for the treatment of hyperkalemia ( 1) Limitation of Use: Sodium polystyrene sulfonate should not be used an emergency treatment for life threatening hyperkalemia because of its delayed onset of action ( 1) Oral: 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 ( 2.1). Rectal: The average adult dose is 30 g to 50 g every six hours ( 2. 1).
The treatment for hyperkalemia is sodium polystyrene sulfonate, a potassium binder. The recommended dose is:
- Oral: 15 g to 60 g per day, administered as 15 g doses, one to four times daily 2
- Rectal: 30 g to 50 g every six hours 2 It is important to note that sodium polystyrene sulfonate should not be used as an emergency treatment for life-threatening hyperkalemia due to its delayed onset of action 2 2.
From the Research
Treatment Options for Hyperkalemia
The treatment for hyperkalemia typically involves a combination of measures to stabilize cardiac membranes, shift potassium from extracellular to intracellular stores, and promote potassium excretion.
- Membrane stabilization can be achieved with calcium gluconate 10% dosed 10 mL intravenously, unless the patient is in cardiac arrest, in which case 10 mL calcium chloride is warranted 3.
- Shifting potassium into cells can be done using beta-agonists and intravenous insulin, with some experts recommending the use of synthetic short-acting insulins rather than regular insulin 3.
- Promoting potassium excretion can be achieved through dialysis, which is the most efficient means of removing excess potassium, as well as loop and thiazide diuretics 3.
- New medications such as patiromer and sodium zirconium cyclosilicate, which promote gastrointestinal potassium excretion, have shown promise in treating hyperkalemia 3, 4.
Pharmacotherapies for Hyperkalemia
Several pharmacotherapies are available to aid in the reduction of serum potassium levels, including:
- Glucose and insulin
- Bicarbonate
- Calcium gluconate
- Beta-2 agonists
- Sodium polystyrene sulfonate (SPS)
- Sodium zirconium cyclosilicate (SZC)
- Patiromer 4, 5 Each of these medications has unique benefits and contraindications, and clinicians must be aware of these when managing patients with hyperkalemia.
Management of Severe Hyperkalemia
Severe hyperkalemia requires prompt recognition and expeditious treatment to prevent potentially lethal complications.
- A physiologically based sequential approach to management is recommended, including membrane stabilization, shifting potassium into cells, and promoting potassium excretion 6.
- Rational use of available agents, including calcium gluconate, beta-agonists, insulin, and dialysis, can help clinicians successfully treat severe hyperkalemia 6, 5.