From the Guidelines
The immediate treatment for hyperkalemia should prioritize stabilizing cardiac membranes with calcium gluconate 10% (10 mL IV over 2-3 minutes) for severe cases (potassium >6.5 mmol/L) or with ECG changes, as recommended by the most recent and highest quality study 1. This approach is crucial for preventing arrhythmias, although it does not lower potassium levels. To shift potassium into cells, administering insulin 10 units IV with 50 mL of 50% dextrose (25g) to prevent hypoglycemia, and considering albuterol 10-20 mg via nebulizer, are effective strategies 1. Sodium bicarbonate 50 mEq IV over 5 minutes may also be beneficial in acidotic patients 1. For potassium removal, options include sodium polystyrene sulfonate 15-30g orally or rectally, or patiromer 8.4g orally, as well as loop diuretics like furosemide 40-80 mg IV for patients with adequate kidney function 1. In cases of life-threatening hyperkalemia unresponsive to medical therapy, hemodialysis is the most effective method 1. Key aspects of management include:
- Continuous cardiac monitoring during treatment
- Identifying and addressing the underlying cause of hyperkalemia to prevent recurrence
- Frequent checks of potassium levels to assess response and guide further interventions Given the potential for variability in symptoms and ECG findings, as noted in the REVEAL-ED study 1, a standardized approach to managing hyperkalemia is essential, taking into account the severity of the condition and the patient's overall clinical status.
From the FDA Drug Label
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 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
The immediate treatment for hyperkalemia is not specified in the provided drug labels. Sodium Polystyrene Sulfonate Powder, for Suspension should not be used as an emergency treatment for life-threatening hyperkalemia due to its delayed onset of action 2, 2, 2.
From the Research
Immediate Treatment for Hyperkalemia
The immediate treatment for hyperkalemia involves several measures to stabilize cardiac membranes, shift potassium from extracellular to intracellular stores, and promote potassium excretion.
- Membrane stabilization can be achieved with calcium gluconate 10% dosed 10 mL intravenously, unless the patient is in cardiac arrest, in which case 10 mL calcium chloride is warranted 3.
- Shifting potassium from extracellular to intracellular stores can be done with beta-agonists and intravenous insulin, with some experts recommending the use of synthetic short-acting insulins rather than regular insulin 3.
- Promoting potassium excretion can be achieved through dialysis, which is the most efficient means of removing excess potassium, as well as loop and thiazide diuretics 3.
- Other treatments include glucose and insulin, bicarbonate, beta-2 agonists, hyperventilation, and dialysis 4.
Medications for Hyperkalemia
Several medications can aid in the reduction of serum potassium levels, including:
- Sodium polystyrene sulfonate (SPS) 4, 5
- Sodium zirconium cyclosilicate (SZC) 3, 4
- Patiromer 3, 4 Each of these medications has unique benefits and contraindications, and clinicians must be aware of these when managing patients with hyperkalemia 4.
Effectiveness of Calcium Gluconate
The effectiveness of calcium gluconate in the treatment of hyperkalemia has been studied, with one study finding that it was effective in improving main rhythm disorders due to hyperkalemia, but not effective in nonrhythm ECG disorders due to hyperkalemia 6.
- Another study reported a case where the administration of calcium salts decreased mortality in a patient with severe hyperkalemia and circulatory shock 7.