What should a patient with hyperkalemia (elevated potassium level) do?

From the Guidelines

A patient with a potassium level of 5.6 should seek immediate medical attention if symptoms like muscle weakness, palpitations, or numbness are present, as hyperkalemia can be life-threatening.

Key Considerations

• The management of acute hyperkalemia depends on the severity of the condition and the presence of symptoms or ECG changes, as noted in the study published in the Mayo Clinic Proceedings 1.
• Treatment options for acute hyperkalemia include intravenous calcium gluconate, insulin/glucose, inhaled β-agonists, intravenous sodium bicarbonate, and hemodialysis, as outlined in the study published in the Mayo Clinic Proceedings 1.
• The European Heart Journal study 1 highlights the importance of evaluating the patient's diet, use of supplements, and concomitant medications that may contribute to hyperkalemia.
• The study published in the European Heart Journal 1 notes that life-threatening hyperkalemia requires immediate treatment with a combination of calcium carbonate and hyperosmolar sodium, insulin with or without glucose, and/or beta adrenoceptor agonists.

Recommendations

• For mild to moderate hyperkalemia, oral medications like sodium polystyrene sulfonate (Kayexalate) or patiromer (Veltassa) may be prescribed to help remove excess potassium through the intestines.
• Severe cases require emergency treatment with intravenous calcium gluconate to protect the heart, insulin with glucose to drive potassium into cells, and possibly nebulized albuterol.
• Diuretics like furosemide may be given to increase potassium excretion through urine, and dialysis might be necessary in life-threatening situations or kidney failure.

Prioritizing Morbidity, Mortality, and Quality of Life

• The primary goal is to prevent cardiac arrhythmias and cardiac arrest, which can be achieved by promptly treating hyperkalemia with the aforementioned therapies.
• The study published in Circulation 1 emphasizes the importance of stabilizing the myocardial cell membrane and shifting potassium into cells to remove it promptly from the circulation.
• By prioritizing morbidity, mortality, and quality of life, healthcare providers can ensure that patients with hyperkalemia receive timely and effective treatment to prevent long-term complications and improve outcomes.

From the Research

Hyperkalemia Overview

• Hyperkalemia is a condition where the serum potassium level is greater than 5.5 mmol/l 2
• It can be caused by impaired renal excretion, transcellular shifts, or increased potassium intake 3
• Symptoms of hyperkalemia can be non-specific, but it can lead to fatal cardiac arrhythmias and muscle paralysis if left untreated 4

Treatment of Hyperkalemia

• For patients with potassium levels of 6.5 mEq/L or greater, or EKG changes, urgent management is warranted, including intravenous calcium, intravenous insulin, and inhaled beta agonists 4, 5
• Hemodialysis can be used in urgent situations, especially in cases of end-stage renal disease or severe renal impairment 4, 3
• For patients with less severe hyperkalemia, renal elimination drugs or gastrointestinal elimination drugs may be used 5
• Newer potassium binders, such as patiromer and sodium zirconium cyclosilicate, may be used in chronic or acute hyperkalemia 6, 3

Emergency Department Visit

• A patient with a potassium level of 5.6 mEq/L may not require immediate emergency department visit unless they have severe symptoms, such as muscle weakness or paralysis, or EKG changes 5
• However, it is essential to monitor the patient's condition and adjust treatment as needed to prevent complications 4, 3
• If the patient's condition worsens or they experience severe symptoms, they should seek immediate medical attention 4, 5