From the Guidelines
The treatment of hyperkalemia should prioritize a stepwise approach based on severity and symptoms, with the most recent evidence from 2021 suggesting that intravenous calcium, insulin, and beta-agonists are crucial for immediate intervention, as stated in the study published in the Mayo Clinic Proceedings 1.
Key Considerations
- For mild hyperkalemia (5.5-6.0 mEq/L), dietary potassium restriction and discontinuation of medications that increase potassium levels may be sufficient.
- For moderate to severe hyperkalemia (>6.0 mEq/L) or when ECG changes are present, immediate intervention is necessary, starting with calcium gluconate (10%, 10 mL IV over 2-3 minutes) to stabilize cardiac membranes, as recommended by the Mayo Clinic Proceedings study 1.
Treatment Protocol
- Intravenous calcium: Administer calcium gluconate (10%, 10 mL IV over 2-3 minutes) to stabilize cardiac membranes and prevent arrhythmias, as supported by the study published in the Mayo Clinic Proceedings 1.
- Insulin and glucose: Administer insulin with glucose (10 units regular insulin with 25g dextrose IV) to shift potassium intracellularly within 15-30 minutes, lasting 4-6 hours, as stated in the study published in the European Heart Journal 1.
- Beta-agonists: Use albuterol nebulization (10-20 mg) to shift potassium into cells, as recommended by the European Heart Journal study 1.
- Sodium bicarbonate: May help in acidotic patients, as suggested by the study published in the European Heart Journal 1.
- Loop diuretics: Use loop diuretics like furosemide (40-80 mg IV) to increase renal excretion in patients with adequate kidney function, as stated in the Mayo Clinic Proceedings study 1.
- Sodium polystyrene sulfonate: Exchange sodium for potassium in the intestine, but works slowly over hours, as recommended by the European Heart Journal study 1.
- Hemodialysis: Remains the most effective method for potassium removal in severe or refractory cases, as stated in the Mayo Clinic Proceedings study 1.
Monitoring and Adjustments
- Continuous cardiac monitoring is essential during treatment, and serial potassium measurements should guide therapy adjustments, as recommended by the Mayo Clinic Proceedings study 1.
- The underlying cause of hyperkalemia must be identified and addressed to prevent recurrence, as stated in the European Heart Journal study 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 protocol for hyperkalemia includes the use of Sodium Polystyrene Sulfonate Powder, for Suspension. However, it is essential to note the following limitation of use:
- Should not be used as an emergency treatment for life-threatening hyperkalemia due to its delayed onset of action 2. Key points to consider:
- Indication: Treatment of hyperkalemia
- Contraindication: Emergency treatment for life-threatening hyperkalemia 2
From the Research
Treatment Protocol for Hyperkalemia
The treatment protocol for hyperkalemia involves several steps, including:
- Stabilizing the cardiac membrane with intravenous calcium gluconate, as seen in patients with hyperkalemic electrocardiography changes 3
- Shifting potassium into cells using insulin, usually with concomitant glucose, and albuterol 3, 4, 5
- Initiating strategies to decrease total body potassium content, such as dialysis or potassium-binding drugs like sodium polystyrene sulfonate, sodium zirconium cyclosilicate, and patiromer 4, 6
Acute Hyperkalemia Treatment
For acute hyperkalemia, treatment is focused on:
- Administering glucose and insulin to lower serum potassium levels 4, 5
- Using bicarbonate, calcium gluconate, beta-2 agonists, and hyperventilation to manage the condition 4
- Considering dialysis for severe cases 4
Chronic Hyperkalemia Treatment
For chronic hyperkalemia, the approach includes:
- Reviewing medications that may be contributing to the disorder and adjusting as needed 6
- Ensuring effective diuretic therapy and correcting metabolic acidosis if present 6
- Using potassium-binding drugs and sodium-glucose cotransporter 2 inhibitors to maintain potassium levels 6
- Considering a nuanced dietary approach, focusing on reducing nonplant sources of potassium 6
Effectiveness of Specific Treatments
Studies have shown that: