What is the treatment for hyperkalemia?

From the Guidelines

The treatment for hyperkalemia involves several approaches depending on severity, and the most effective method for potassium removal in severe cases or renal failure is hemodialysis, as supported by recent studies 1. For mild hyperkalemia (potassium 5.5-6.0 mEq/L), dietary potassium restriction and discontinuation of medications that increase potassium levels (like ACE inhibitors, ARBs, and potassium-sparing diuretics) may be sufficient.

• Key considerations in managing hyperkalemia include:
  • Monitoring serum potassium levels closely, especially in patients with chronic kidney disease, diabetes, heart failure, or a history of hyperkalemia, and those receiving RAASi therapy 1.
  • Using newer K+-binding agents like patiromer or sodium zirconium cyclosilicate to facilitate optimization of RAASi therapy 1.
  • Implementing quality improvement programs to improve rates of laboratory monitoring for patients initiated on MRA therapy, particularly in high-risk patients 1. For moderate to severe hyperkalemia (potassium >6.0 mEq/L), more urgent interventions are needed, including:
• Calcium gluconate (10 mL of 10% solution IV over 2-3 minutes) to stabilize cardiac membranes and prevent arrhythmias.
• Insulin with glucose (10 units regular insulin with 25g dextrose IV) to drive potassium into cells temporarily, lowering serum levels within 15-30 minutes.
• Inhaled beta-2 agonists like albuterol (10-20 mg nebulized) to shift potassium intracellularly.
• Sodium bicarbonate (50 mEq IV over 5 minutes) to help in acidotic patients.
• Loop diuretics like furosemide (40-80mg IV) to enhance renal potassium excretion in patients with adequate kidney function. Treatment should be tailored to the clinical situation, with continuous cardiac monitoring for patients with severe hyperkalemia or ECG changes, as emphasized in recent clinical guidelines 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 2. However, it should not be used as an emergency treatment for life-threatening hyperkalemia due to its delayed onset of action.

• Key points:
  • Indicated for hyperkalemia treatment
  • Not for emergency treatment of life-threatening hyperkalemia 2 also supports this treatment indication.

From the Research

Treatment Overview

• Hyperkalemia is a common electrolyte disorder that can result in morbidity and mortality if not managed appropriately 3.
• The treatment of hyperkalemia includes measures to stabilize cardiac membranes, shift potassium from extracellular to intracellular stores, and promote potassium excretion 3, 4.

Stabilization of Cardiac Membranes

• 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.
• This step is crucial in preventing cardiac dysrhythmias, which can be life-threatening 3.

Shifting Potassium into Cells

• Beta-agonists and intravenous insulin should be given to shift potassium into cells 3.
• 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.

Promoting Potassium Excretion

• Dialysis is the most efficient means to enable removal of excess potassium 3.
• Loop and thiazide diuretics can also be useful in promoting potassium excretion 3.
• Sodium polystyrene sulfonate is not efficacious in treating hyperkalemia 3.

New Medications

• New medications to promote gastrointestinal potassium excretion, which include patiromer and sodium zirconium cyclosilicate, hold promise in treating hyperkalemia 3, 5.
• These medications can allow for a less restrictive potassium diet and lower renin-angiotensin-aldosterone system inhibitors discontinuation rates 5.

Approach to Chronic Hyperkalemia

• The approach to patients with chronic hyperkalemia begins with a review of medications potentially responsible for the disorder, ensuring effective diuretic therapy and correcting metabolic acidosis if present 4.
• Restricting foods high in potassium to manage hyperkalemia is being reassessed, and dietary restriction should be more nuanced, focusing on reducing the intake of nonplant sources of potassium 4.