From the Guidelines
The treatment for hyperkalemia involves a multi-modal approach, including calcium gluconate to stabilize cardiac membranes, insulin and glucose to shift potassium intracellularly, and potassium binders or loop diuretics to enhance potassium elimination, as recommended by the most recent study 1. The management of hyperkalemia depends on the severity of the condition, with mild cases potentially being managed with dietary restrictions and discontinuation of medications that increase potassium levels, while more severe cases require immediate intervention to prevent cardiac arrhythmias and other complications.
- For acute hyperkalemia, calcium gluconate (10 mL of 10% solution IV over 2-3 minutes) is given first to stabilize cardiac membranes and prevent arrhythmias 1.
- This is followed by insulin (10 units regular insulin IV) with glucose (25-50g IV) to shift potassium into cells temporarily, and albuterol nebulization (10-20 mg) can also help shift potassium intracellularly 1.
- For definitive removal of potassium, sodium polystyrene sulfonate (15-30g orally or rectally) or newer potassium binders like patiromer (8.4-25.2g daily) or sodium zirconium cyclosilicate (10g three times daily initially) can be used 1.
- Loop diuretics like furosemide (40-80mg IV) enhance potassium excretion in patients with adequate kidney function, and in severe cases or when other measures fail, hemodialysis provides rapid and effective potassium removal 1. The frequency of potassium monitoring should be individualized based on patient comorbidities and medications, particularly in patients at high risk for development of hyperkalemia, and the use of newer potassium binders may enable the optimization of renin-angiotensin-aldosterone system inhibitor therapy in more patients with hyperkalemia 1.
From the FDA Drug Label
Sodium Polystyrene Sulfonate Powder, for Suspension is indicated for the treatment of hyperkalemia (1). Limitation of Use: Sodium Polystyrene Sulfonate Powder, for Suspension should not be used as an emergency treatment for life-threatening hyperkalemia because of its delayed onset of action (1).
The treatment for hyperkalemia is Sodium Polystyrene Sulfonate Powder, for Suspension. However, it should not be used as an emergency treatment for life-threatening hyperkalemia due to its delayed onset of action 2.
- Key points:
- Indicated for hyperkalemia treatment
- Not for emergency treatment of life-threatening hyperkalemia
- This information is also supported by another study 2.
From the Research
Treatment for Hyperkalemia
The treatment for hyperkalemia involves several strategies, including:
- Stabilizing cardiac membranes with calcium gluconate 3, 4, 5
- Shifting potassium into cells using insulin and beta-agonists 3, 4, 6, 5
- Eliminating excess potassium from the body through diuresis, oral binding resins, and hemodialysis 3, 4, 5
- Correcting underlying causes, such as medication-induced hyperkalemia or metabolic acidosis 7
Emergency Treatment
In cases of severe hyperkalemia with ECG changes, emergency treatment is necessary and includes:
- Administering calcium gluconate to stabilize cardiac membranes 3, 4, 5
- Using intravenous insulin and inhaled beta-2 agonists to shift potassium into cells 3, 4, 6, 5
- Initiating measures to eliminate excess potassium, such as intravenous furosemide or renal replacement therapy 3, 4, 5
Chronic Hyperkalemia Management
For chronic hyperkalemia, treatment involves:
- Reviewing and adjusting medications that may be contributing to hyperkalemia 7
- Ensuring effective diuretic therapy and correcting metabolic acidosis if present 7
- Using potassium-binding drugs and sodium-glucose cotransporter 2 inhibitors to maintain potassium levels 7
- Implementing a nuanced dietary approach, focusing on reducing nonplant sources of potassium 7