From the Guidelines
Hyperkalemia treatment should prioritize the use of calcium gluconate, insulin, and beta-agonists to rapidly lower potassium levels, followed by the use of potassium binders such as patiromer or sodium zirconium cyclosilicate for definitive removal of potassium, as recommended by the most recent study 1.
Treatment Approach
The treatment of hyperkalemia depends on the severity and symptoms of the condition. For mild hyperkalemia, dietary potassium restriction and discontinuation of medications that increase potassium levels may be sufficient. However, for moderate to severe hyperkalemia or when ECG changes are present, more aggressive treatment is needed.
Acute Management
- Calcium gluconate 10% (10 mL IV over 2-3 minutes) can be given to stabilize cardiac membranes and prevent arrhythmias, as shown in the study 1.
- Insulin (10 units regular insulin IV) with glucose (25-50g IV) drives potassium into cells temporarily, lowering serum levels within 15-30 minutes.
- Albuterol nebulizer (10-20 mg) also shifts potassium intracellularly.
- Sodium bicarbonate (50 mEq IV over 5 minutes) may help in acidotic patients.
Definitive Removal of Potassium
- Sodium polystyrene sulfonate (15-30g orally or rectally) can be used, but it has been shown to be less effective than newer potassium binders 1.
- Patiromer (8.4-25.2g daily) or sodium zirconium cyclosilicate (10g three times daily) are recommended for definitive removal of potassium, as they have been shown to be effective in normalizing elevated potassium levels and preventing recurrences of hyperkalemia 1.
- Loop diuretics like furosemide (40-80mg IV) enhance renal potassium excretion in patients with adequate kidney function.
- Hemodialysis is the most effective method for severe or refractory hyperkalemia, especially in patients with kidney failure.
Ongoing Monitoring
Ongoing monitoring of potassium levels and cardiac status is essential during treatment, as recommended by the study 1. This includes regular checks of potassium levels, ECG monitoring, and assessment of cardiac function.
Key Considerations
- The use of renin-angiotensin-aldosterone system inhibitors (RAASi) can increase potassium levels, and therapies aimed at lowering potassium levels should be considered to enable patients to continue RAASi therapy, as recommended by the study 1.
- A low-potassium diet and loop or thiazide diuretics that increase potassium excretion may be considered to reduce the occurrence of hyperkalemia, as recommended by the 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 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. The average total daily adult dose is 15 g to 60 g, administered orally as a 15-g dose, one to four times daily, or 30 g to 50 g rectally every six hours 2.
From the Research
Treatment Options for Hyperkalemia
The treatment for hyperkalemia, a condition characterized by elevated potassium levels, can be acute or chronic, depending on the severity and underlying cause of the condition. The following are some of the treatment options available:
- Acute treatment:
- Administration of intravenous calcium salts to stabilize the resting cardiac membrane potential 3, 4, 5, 6
- Intravenous insulin combined with an infusion of glucose to stimulate intracellular uptake of potassium 3, 4, 5, 6
- Nebulized β-2 adrenoceptor agonists, such as albuterol, to augment the effects of intravenous insulin and glucose 3, 4, 5, 6
- Dialysis, preferably hemodialysis, to remove excess potassium from the body 3, 5
- Chronic treatment:
- Diuretics, such as furosemide, to increase potassium excretion 5
- Cation exchange resins, such as sodium polystyrene sulfonate (SPS) or sodium zirconium cyclosilicate (SZC), to remove excess potassium from the body 3, 4
- Patiromer, a potassium-binding medication, to reduce serum potassium levels 3
- Restriction of potassium intake and careful review of prescribed drugs that may be adversely affecting potassium homeostasis 6
Considerations for Treatment
When treating hyperkalemia, it is essential to consider the underlying cause of the condition, as well as any potential interactions with other medications or medical conditions. The following are some key considerations:
- Identifying and addressing the underlying cause of hyperkalemia, such as kidney disease or medication use 3, 4, 7, 6
- Monitoring serum potassium levels and electrocardiogram (ECG) changes to assess the effectiveness of treatment 3, 4, 5, 6
- Adjusting treatment as needed to prevent rebound hyperkalemia or hypokalemia 4
- Implementing institutional protocols for the management of hyperkalemia to improve patient safety 6