From the Guidelines
Treatment for hyperkalemia should prioritize immediate stabilization of cardiac membranes with calcium gluconate, followed by measures to shift potassium into cells, and ultimately remove excess potassium from the body, as outlined in the most recent guidelines 1.
Key Considerations
- Hyperkalemia is a life-threatening condition that requires prompt treatment to prevent cardiac arrhythmias and death.
- The management of hyperkalemia depends on the severity of the condition, with mild cases potentially being managed with dietary restrictions and discontinuation of potassium-sparing medications.
- For moderate to severe hyperkalemia, more aggressive interventions are necessary, including:
- Calcium gluconate to stabilize cardiac membranes
- Insulin and glucose to shift potassium into cells
- Inhaled beta-2 agonists to promote intracellular potassium shift
- Sodium bicarbonate in acidotic patients
- Sodium polystyrene sulfonate or other potassium-binding agents to remove potassium from the body
- Loop diuretics to increase renal potassium excretion
- Hemodialysis in severe or refractory cases
Recent Guidelines
The most recent guidelines on the management of hyperkalemia, published in 2021, emphasize the importance of individualized monitoring of serum potassium levels, particularly in patients with chronic kidney disease, diabetes, heart failure, or a history of hyperkalemia 1.
Treatment Options
- Calcium gluconate: 10 mL of 10% solution IV over 2-3 minutes to stabilize cardiac membranes
- Insulin and glucose: 10 units regular insulin with 25g dextrose IV to shift potassium into cells
- Inhaled beta-2 agonists: 10-20 mg nebulized to promote intracellular potassium shift
- Sodium bicarbonate: 50 mEq IV over 5 minutes in acidotic patients
- Sodium polystyrene sulfonate: 15-30g orally or rectally to remove potassium from the body
- Loop diuretics: 40-80mg IV to increase renal potassium excretion
- Hemodialysis: in severe or refractory cases to provide rapid potassium removal These treatments work through different mechanisms to lower potassium levels quickly and safely, and the underlying cause of hyperkalemia should also be identified and addressed to prevent recurrence 1.
From the FDA Drug Label
1 INDICATIONS AND USAGE Sodium Polystyrene Sulfonate Powder, for Suspension is indicated for the treatment of hyperkalemia.
Treatment for hyperkalemia includes the use of Sodium Polystyrene Sulfonate Powder, for Suspension.
- However, it is noted that this treatment should not be used as an emergency treatment for life-threatening hyperkalemia due to its delayed onset of action 2.
From the Research
Treatment Options for Hyperkalemia
- The treatment of hyperkalemia includes measures to stabilize cardiac membranes, shift potassium from extracellular to intracellular stores, and promote potassium excretion 3.
- 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 3.
- Beta-agonists and intravenous insulin should be given, and some experts recommend the use of synthetic short-acting insulins rather than regular insulin 3.
- Dextrose should also be administered, as indicated by initial and serial serum glucose measurements 3.
- Dialysis is the most efficient means to enable removal of excess potassium 3.
- Loop and thiazide diuretics can also be useful in removing potassium from the body 3.
Effectiveness of Calcium Gluconate
- A study found that intravenous calcium gluconate therapy was effective in improving main rhythm disorders due to hyperkalemia, but not effective in nonrhythm ECG disorders due to hyperkalemia 4.
- The study suggested that calcium gluconate may be effective only in the main rhythm disorders due to hyperkalemia 4.
Other Treatment Measures
- Insulin is the most reliable agent for promoting transcellular shift of potassium 5.
- Albuterol can be used alone or to augment the effect of insulin 5.
- Hemodialysis rapidly and reliably removes potassium and lowers potassium levels 5.
- Exchange resins are also useful in removing potassium from the body 5.
- New medications to promote gastrointestinal potassium excretion, such as patiromer and sodium zirconium cyclosilicate, hold promise in the treatment of hyperkalemia 3, 6.
Prevention and Clinical Management
- The plasma pool of potassium is a partial reflection of the overall body, transient cellular shifts, and potassium elimination regulated by the kidneys 6.
- Potassium concentrations elevating above the upper limit of normal have become more common in cardiovascular practice due to the growing population of patients with chronic kidney disease and the broad applications of drugs that modulate potassium excretion 6.
- Traditional management steps have included reducing dietary potassium and discontinuing potassium supplements, withdrawal of exacerbating drugs, and acute treatment with intravenous calcium gluconate, insulin, and glucose 6.