What is the treatment for hyperkalemia (elevated potassium levels)?

From the Guidelines

Treatment for hyperkalemia should focus on lowering potassium levels quickly and safely, with the approach depending on the severity and underlying cause, as recommended by the most recent and highest quality study 1. The treatment options for hyperkalemia can be categorized based on the severity of the condition:

• For mild to moderate hyperkalemia (K+ 5.5-6.5 mmol/L):
  • Stop potassium-containing medications and foods
  • Administer oral potassium binders like sodium polystyrene sulfonate (Kayexalate) 15-30g orally every 6 hours
  • Loop diuretics like furosemide 40-80mg IV or orally to increase potassium excretion
  • Insulin with glucose: 10 units regular insulin IV with 50mL of 50% dextrose to shift potassium intracellularly
• For severe hyperkalemia (K+ >6.5 mmol/L) or with ECG changes:
  • Calcium gluconate 10% solution, 10mL IV over 2-3 minutes to stabilize cardiac membranes
  • Insulin with glucose as above
  • Nebulized albuterol 10-20mg to shift potassium intracellularly
  • Sodium bicarbonate 150mEq in 1L D5W over 2-4 hours if metabolic acidosis is present
  • Consider emergency dialysis if refractory or in renal failure It is essential to monitor potassium levels closely and repeat treatments as needed, addressing the underlying cause to prevent recurrence, as highlighted in the study 1. The treatments work by different mechanisms: calcium stabilizes cardiac membranes, insulin and albuterol shift potassium into cells, while diuretics and binders increase potassium excretion, as explained in the study 1. Prompt treatment is crucial as severe hyperkalemia can lead to life-threatening arrhythmias, emphasizing the importance of timely and effective management, as noted in the study 1. Additionally, the use of new K+ binders, such as patiromer and sodium zirconium cyclosilicate, can help manage hyperkalemia and enable patients to continue renin-angiotensin-aldosterone system inhibitors (RAASi) therapy, as discussed in the study 1.

From the FDA Drug Label

1 INDICATIONS AND USAGE Sodium Polystyrene Sulfonate Powder, for Suspension is indicated for the treatment of hyperkalemia.

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 treatment for hyperkalemia is Sodium Polystyrene Sulfonate Powder, for Suspension.
• It is not recommended for emergency treatment of life-threatening hyperkalemia.

From the Research

Treatment Overview

The treatment for hyperkalemia (elevated potassium levels) involves several steps, including:

• Elimination of reversible causes (diet, medications) 3
• Rapidly acting therapies that shift potassium into cells and block the cardiac membrane effects of hyperkalemia 3, 4
• Measures to facilitate removal of potassium from the body (saline diuresis, oral binding resins, and hemodialysis) 3, 4

Emergency Treatment

In cases of severe hyperkalemia (potassium level more than 6.5 mEq/L or EKG changes), treatment should be started with:

• Calcium gluconate to stabilize cardiomyocyte membranes 3, 4, 5, 6
• Insulin injection to shift potassium into cells 3, 4, 6
• Beta-agonists administration to augment the effects of insulin 3, 4, 6

Removal of Potassium

Hemodialysis remains the most reliable method to remove potassium from the body and should be used in cases refractory to medical treatment 3, 4 Other measures to facilitate removal of potassium include:

• Saline diuresis 3
• Oral binding resins 3
• Loop and thiazide diuretics 4
• Sodium polystyrene sulfonate (although its efficacy is limited) 4
• New medications to promote gastrointestinal K+ excretion, such as patiromer and sodium zirconium cyclosilicate 4

Chronic Hyperkalemia Management

The approach to patients with chronic hyperkalemia begins with:

• Review of medications potentially responsible for the disorder 7
• Ensuring effective diuretic therapy 7
• Correcting metabolic acidosis if present 7
• Dietary restriction, focusing on reducing the intake of nonplant sources of K+ 7
• Use of K+ binding drugs and sodium-glucose cotransporter 2 inhibitors to maintain the use of renin-angiotensin-aldosterone inhibitors 7