From the Guidelines
A potassium level of 6 mEq/L is considered severe hyperkalemia and requires immediate medical attention. This condition can lead to dangerous heart rhythm abnormalities, including cardiac arrhythmias, ventricular fibrillation, and cardiac arrest 1. According to the European Heart Journal, the severity of hyperkalemia can be classified as mild, moderate, or severe, with levels above 6.0 mEq/L considered severe 1.
Key Considerations
- The risk of arrhythmic emergencies and sudden arrhythmic death in patients with hyperkalemia is widely variable, and life-threatening arrhythmias may occur at different thresholds 1.
- Patients with chronic kidney disease, diabetes, or heart failure may have higher potassium levels without showing signs of arrhythmia, but this does not diminish the need for prompt treatment 1.
- Treatment for severe hyperkalemia typically includes stabilizing the heart with calcium gluconate, shifting potassium into cells with insulin and glucose, and removing potassium from the body with sodium polystyrene sulfonate (Kayexalate) or patiromer 1.
Recommendations
- Seek immediate medical care at an emergency department if you have a potassium level of 6 mEq/L.
- Avoid high-potassium foods and medications that can raise potassium, such as ACE inhibitors, ARBs, potassium-sparing diuretics, and NSAIDs, until medically cleared.
- Follow the treatment plan prescribed by your healthcare provider, which may include calcium gluconate, insulin with glucose, sodium bicarbonate, and potassium-removing medications.
From the Research
Definition and Severity of Hyperkalemia
- Hyperkalemia is a common electrolyte disorder that can result in morbidity and mortality if not managed appropriately 2.
- It is usually detected via serum clinical laboratory measurement, and the most severe effect of hyperkalemia includes various cardiac dysrhythmias, which may result in cardiac arrest and death 2.
- A potassium level of 6 is considered severe hyperkalemia, as it can lead to adverse outcomes, especially due to severe cardiac arrhythmias 3.
Treatment of Hyperkalemia
- Treatment includes measures to "stabilize" cardiac membranes, to shift K+ from extracellular to intracellular stores, and to promote K+ excretion 2.
- Calcium gluconate 10% dosed 10 mL intravenously should be provided for membrane stabilization, unless the patient is in cardiac arrest, in which case 10 mL calcium chloride is warranted 2.
- Beta-agonists and intravenous insulin should be given, and some experts recommend the use of synthetic short-acting insulins rather than regular insulin 2.
- Dialysis is the most efficient means to enable removal of excess K+, and loop and thiazide diuretics can also be useful 2.
Management and Monitoring
- Hyperkalemia can be deadly, and treatment requires specific measures including membrane stabilization, cellular shift, and excretion 2.
- Potassium levels should be monitored closely for high-risk patients, as it is associated with adverse outcomes 3.
- New therapies, such as patiromer and sodium zirconium cyclosilicate, have demonstrated effective control, offering hope for potential use in patients that would benefit from diet or medications associated with an increase in serum potassium 3.
- The use of anti-hyperkalemic agents may allow for a less restrictive potassium diet and lower RAASi discontinuation rates 3.
Clinical Considerations
- Electrocardiography identifies cardiac conduction disturbances but may not correlate with serum potassium levels 4.
- Emergent treatment is recommended for patients with clinical signs and symptoms (e.g., muscle weakness, paralysis) or if electrocardiography abnormalities are present 4.
- Acute treatment may include intravenous calcium, insulin, sodium bicarbonate, diuretics, and beta agonists 4.
- Hypoglycemia after insulin use is a frequent complication during hyperkalemia management, and several strategies can reduce the risk of hypoglycemia with insulin therapy 5.